Championship Softball Academy
PARENT'S NAME: _____________________________________________________________
PLAYER'S NAME: __________________________________________AGE:_______________
SIBLING DISCOUNTS: Take $5.00 off each additional child. Multi-camp discount: $5.00 off each additional clinic
PLEASE CHECK APPROPRIATE BOX:
Clinic Dates: ____________________________________ Amount Paid:__________________
Pitching: _____________________________ Hitting: ________________________________
Pitching Challenge Dates: __________________________ Amount Paid:________________
Hitting Challenge Dates: ____________________________ Amount Paid:________________
TOTAL AMOUNT PAID: ________________________ (cash / check # __________________)
I, the undersigned, waive, release and forever discharge Championship Softball Academy, Robin Payne and her staff and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in clinic activity or while at the clinic, whether or not damages, injury or loss is due to negligence.
I, the undersigned certify that _________________________________ is physically qualified to participate.
parent signature / date