* Participants age as of October 3, 2008:

Select age level 8 9 10 11 12 13 14 15 16 17 18

* Participant's full/legal last name:

* Participant's full first name:

* Date of Birth (mm/dd/yr):

* Mailing address (Line 1):

Mailing address (Line 2):

* City:

* State:

MA CT ME NH RI VT

* Zip Code:

* Telephone Contact:

* Email Address Contact:

* Parent/Guardian Name(s):

* Emergency contact names and numbers (at least 1 is required):

* Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement:

The Participant and/or Participant’s parent(s)/ guardian(s) acknowledge, understand and assume all risks inherent with participating in this program/tryout.

I, the parent/guardian of the above named Participant, hereby give my consent for their participation in “The Strike Zone” program/clinic/camp/tryout/etc..  Also, I hereby release, indemnify and agree to hold harmless “The Strike Zone” and any of its directors, officers, coaches, agents, affiliates, sponsors, and associated personnel against any legal claim by or on behalf of the participant as a result of participation in the program.  I also give my consent for all medical care prescribed by a medical doctor, EMT or nurse to preserve the physical well being of my child.

By typing my full legal first and last name below, I accept the terms of the aforementioned Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement.

Please note: this is the Parent's or Guardian's name...not the player's name.

If there is additional information you wish to submit with the application, please include it here:

Please click the "Submit" button below only once and please

be patient as you are redirected to our payment webpage.