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Adult Program Sign Up
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Address
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Date of Birth
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Shirt Size:
Does the Player use a walker or wheelchair?
Disability Diagnosis:
Alergies:
Is residency a Group Home?

(If Applicable)
Agency Affiliation:
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Release Form 2010

*Mandatory Section
In consideration for the Miracle League of Westchester, Inc. providing the opportunity for this consumer to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless the Miracle League of Westchester, Inc and its officers and directors from any and all claims for personal injury, death, property damage, or any type of claim or damage (including but not limited to attorney's fees or litigation expenses) resulting from this consumer’s activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned. We assume all risks and hazards incidental to such participation in Miracle League games and activities and consent for this consumer to receive first-aid and/or emergency care by a qualified Emergency Medical Technician or physician or other person qualified to render medical assistance in the event this consumer suffers an injury during sanctioned games and activities. I agree to provide this consumer’s specific medical information to the Miracle League of Westchester, Inc. so that appropriate precautions and care can be provided to this consumer during sanctioned games and activities. We agree to be present at all games and activities so that w e can manage this consumer’s specific needs. We agree to have any and all medication (prescription and nonprescription) for this consumer and shall be solely responsible for dispensing any such medication to this consumer.
Guardian Signature
Date

Photo Release Form 2010

*Optional Section
We understand that there will be media and promotional coverage of Miracle League Games and activities and We give our consent to publish this consumer’s name and picture for such purposes. We hereby grant the Miracle League of Westchester, Inc., its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing his/her name, voice, likeness or any other identifiable representation of this consumer/Miracle league player. These materials may appear in any form, style, color or medium whatsoever (including, without limitation, photographs, video tapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media). We agree that all material containing identifiable representation of me (including without limitation, all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of the Miracle League of Westchester. We hereby release and forever discharge the Miracle League of Westchester, Inc. from any and all liability and damages relating to this consumer’s, voice, likeness or any identifiable representation of me. We hereby waive any right we may have to inspect or approve the finished materials or any part or element thereof that incorporates this consumer’s, voice, likeness or any other identifiable representation of this Miracle League player/consumer. We have agreed to the above in consideration of the opportunity given to me by the Miracle League of Westchester, Inc. to appear in these materials.
Guardian Signature
Date