ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT

Transcription

1 -ALLTRYOUTSAT URBAN YOUTH ACADEMY 2801S.Vi ct orydr. ;Hous t on,tx PREREGI STER ONLI NEAT: ASTROS. COM/ UYA

2 FOR OFFICE USE ONLY DIVISION: SOFTBALL JUNIOR SENIOR TRYOUT NO. ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT RBI PROGRAM PLAYER RELEASE WAIVER HOUSTON ASTROS WAIVER OF LIABILITY RBI PROGRAM APPLICATION AND MEDICAL CONSENT FORM COPY OF BIRTH CERTIFICATE COPY OF MOST RECENT PHYSICAL PLEASE BRING ALL SIGNED FORMS WITH YOU TO YOUR SCHEDULED TRYOUT DATE. Houston Astros Urban Youth Academy 2801 S. Victory Dr. Houston, TX Phone: (281)

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4 Houston Astros Major League Baseball Urban Youth Academy at Sylvester Turner Park RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (Participant/Child Texas) In consideration of (the Player ) being permitted to participate in the Houston Astros Major League Baseball Urban Youth Academy ( the Program ), offered by or through the Houston Astros LLC and the Commissioner of Baseball d/b/a Major League Baseball, the player and his/her parent(s) or legal guardian(s) hereby voluntarily agree to the following: RELEASE FROM LIABILITY AND COVENANT NOT TO SUE: Each player and his/her parent or guardian agrees, for him/herself and his/her personal representatives, executors, administrators, heirs, next of kin, successors and assigns, hereby acknowledges, agrees and represents that he or she has carefully considered participation in each such program and has or will inspect and carefully consider any premises, facilities or equipment to be used in connection with each such program prior to the use thereof by the undersigned and/or such child. It is further warranted that such participation and the use of such premises, facilities or equipment constitutes acknowledgement that such programs and the premises, facilities and equipment to be used in connection therewith have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such participation or use by the undersigned and/or such child. Each player and his/her parent(s) or legal guardian(s), for him/herself and his/her personal representatives, executors, administrators, heirs, next of kin, successors and assigns agree to release and forever discharge the Program, each organizer, promoter and sponsor of the Program of the League, the Houston Astros Major League Baseball Urban Youth Academy, Houston Astros LLC, Astros In Action Foundation, the Major League Urban Youth Foundation, the member clubs of Major League Baseball, the Office of the Commissioner of Baseball, Major League Baseball Properties, Inc., Major League Baseball Enterprises, Inc., MLB Advanced Media, LP, MLB Advanced Media, Inc., Major League Baseball Charity, Inc., each person or entity responsible for transporting the Player to or from Program or League activities, and all of the respective past, present and future owners (direct and indirect), officers, directors, employees, agents, committees of each of the foregoing and each of their successors and assigns, the Releasees, from, and waive in respect of each Releasee and covenant not to sue any Releasee for, any liabilities, losses, damages, costs, expenses (including, but not limited to, attorney fees and expenses), actions, causes of actions, suits, obligations, judgments of any nature whatsoever (collectively, the Liabilities )arising from, based upon or relating to personal injury or death to, or damage to or loss of property of, the Player or his/her parent(s) or guardian(s)sustained in connection with the player s participation in the Program or League. Such release, discharge, waiver and covenant not to sue shall include, but not be limited to, any and all such Liabilities caused in whole or in part by the negligence of any release in connection with such Releasee s involvement with the Program or League (for example, in connection with such Releasee s training or personnel). PLAYER ASSUMES RISK: Each of the Player and his/her parent(s) or guardian(s) is aware of and understands the inherent risk and dangers of baseball and softball and the potential for injury that exists when participating in this activity, and agrees to assume all risk of and responsibility for personal injury or death to, or damage to or loss of property, the Player arising from, based upon or relating to the Release, Waiver of Liability and Indemnity Agreementplayer s participation in the Program or League. Such assumptions of risk include, but are not limited to, any personal injury or death, or damage to loss of property, arising from, based upon or relating to the lack of skill of any player, the improper conduct of any players and acts of omissions of any referee, coach or supervisor, and any personal injury or death, or damage to or loss of property, caused in whole or in part by the negligence of any Releasee. Each of the Player and his/her parent(s) or his/her guardian(s) understands and agrees, that in the event of an injury to the Player, none of the Releasees will be responsible for any decision relating to medical treatment for Player or for such treatment itself. RIGHT OF PUBLICITY: Participation in the Program shall constitute permission to use the name, likeness or any other identification for commercial or promotional advertising, publicity, instructional or any other purposes in connection with the Program or the league or the business of any of the Releasees, in any medium, at any time and from time to time, without compensation to or right or prior review or approval by the Player or his/her parent(s) or guardian(s).

5 Each of the Player and his/her parent(s) or guardian(s) agrees, for him/herself and his/her personal representatives, executors, heirs, next of kin, successors and assigns, to release and discharge each Releasee from, to waive in respect of each Releasee, and not to sue any Releasee for, any and all liabilities arising from, based upon or relating to any claim for invasion of privacy, violation of right of publicity, defamation or appropriation, or any similar claim, in connection with any such use. MISCELLANEOUS: The undersigned further expressly agrees that this Release, Waiver of Liability and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. This agreement shall be governed by and construed in accordance with the laws of the State of Texas, without regard to conflict of laws principles. The courts of Texas shall be the sole jurisdiction for all disputes. REPRESENTATIONS: Each of the Player and his/her parent(s) or guardian(s) states that he/she has had full opportunity to ask questions regarding the Program and the League that he/she may have, that he/she has read and understands this release, discharge, waiver and covenant not to sue (or that the parent of guardian has read and understands this release, discharge, waiver and covenant not to sue, and has explained it to the Player) and that he/she has been given the opportunity to review this release, discharge, waiver and covenant not to sue with anyone he/she chooses, including a lawyer, and has done so to the extent he/she wishes to do so. Each of the Player and his/her parent(s) or guardian(s) further states that the player has been examined by a doctor within the past six (6) months and is in good physical condition, is physically fit to participate in the Program and the League and is not subject to any medical condition that poses risk of harm or disability to others. THE UNDERSIGNED ACKNOWLEDGES THAT HE OR SHE HAS READ THE RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, AND FULLY UNDERSTANDS THE PROVISIONS AND COVENANTS CONTAINED IN THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT. THE UNDERSIGNED IS AWARE THAT BY SIGNING THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, THE UNDERSIGNED MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. THE UNDERSIGNED VOLUNTARILY SIGNS THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, AND FURTHER AGREES THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. Release, Waiver of Liability and Indemnity Agreement THE UNDERSIGNED ACKNOWLEDGES THAT IN THE EVENT OF THE UNDERSIGNED S DEATH OR INCAPACITY, THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON THE UNDERSIGNED S HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES. I HAVE READ AND UNDERSTAND THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT. Printed Name of Participant Signature of Participant Date (A PARENT OR GUARDIAN MUST ALSO SIGN IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE.) Printed Name of Parent(s)/Guardian(s) Signature of Parent(s)/Guardian(s) Date

6 RBI Program Application and Medical Consent Form Baseball Softball LEAGUE NAME PLAYER INFORMATION Name (last) (first) (M.I.) Permanent Address: City State Zip School HS Graduation Year Birthdate Country of Origin How long have you lived in the United States? (years) Ethnic Origin: Asian Black Latino Native American White Other Name of Parent(s), Spouse, or Guardian (circle one) Address (no.) (street) (city) (state) (zip) (country) Telephone: Work ( ) Home ( ) Cell ( ) IN CASE OF EMERGENCY, CONTACT THE FOLLOWING INDIVIDUAL IF THE PERSON ABOVE CANNOT BE REACHED: Name Relationship Address (no.) (street) (city) (state) (zip) (country) Telephone: Work ( ) Home ( ) Cell ( ) Name of Physician or Clinic that you usually consult for medical care: Address Phone ( ) (no.) (street) (city) (state) (zip) INSURANCE INFORMATION Health Insurance Company Name Address City State Zip Telephone( ) Policy Number Subscriber Name Subscriber Social Security # - - PERMISSION FOR TREATMENT IN CASE OF IMMEDIATE NEED If your son/daughter is a minor (under 18 years of age), you as a parent or legal guardian must sign this consent form so that the RBI Program can provide appropriate diagnosis and treatment and emergency health service procedures may be promptly carried out with no unnecessary delay. Without a signed permission for treatment, your minor son/daughter cannot receive treatment unless his/her presenting condition is exempted from requiring parental consent and/or notification. Even with a signed permission for treatment, we will attempt to contact and fully inform you as parent legal guardian before performing any major diagnostic/treatment procedure except in an emergency. It should be understood that under certain circumstances your son/daughter will be transported for diagnosis and treatment. I certify that the foregoing information is true and complete to the best of my knowledge. I give my permission to the RBI Program to furnish such diagnostic, therapeutic, voluntary immunization, and/or operative procedures and/or transportation as may be deemed necessary by the RBI Program for my son/daughter who is under the age of 18 years. I am aware that the practice of medicine is not an exact science, and I acknowledge that no guarantees have been made to me as the result of treatment or examination. I further acknowledge that the terms of the RBI program player release & waiver (including, without limitation, the section titled RELEASE FROM LIABILITY AND COVENANT NOT TO SUE) are hereby incorporated by reference. Signature of Parent/Guardian Name of Parent/Guardian (please print) Date