Please cleary fill out all fields:
Volunteer/Buddy
First Name (required, please enter clearly)
Middle Initial (required, please enter clearly)
Last Name (required, please enter clearly)
Address
City
State
Zip Code
Home Phone
Cell Phone
E-Mail Address
Date of Birth
Are you over 16?
Drivers License Number(if over 16) (necessary and mandatory for security check, please enter clearly)
State in which you hold your Drivers License (necessary and mandatory for security check, please choose carefully)
Participation Interest
Buddy:
Coach:
Fund Raising:
Team Parent:
Do you need volunteer verification of community service hours?
Game Day and Time Preference:
Release Form 2010 *Mandatory Section
In consideration for Miracle League of Westchester, Inc. providing the opportunity for me to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless Miracle League of Westchester, Inc., 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 my child's activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned. I consent for my child to receive first aid and/or emergency medical care in the event of an injury.
I/We assume all risks and hazards incidental to such participation in Miracle League games and activities and consent 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 I suffer an injury during sanctioned games and activities.
Adult Volunteer Signature
Date
Photo Release Form 2010 *Optional Section
I understand that there will be media and promotional coverage of Miracle League Games and activities and I give my consent to publish my name and picture for such purposes. I hereby grant the Miracle League of Westchester, its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness or any other identifiable representation of myself and my family members. 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). I 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. I hereby release and forever discharge The Miracle League Of Westchester from any and all liability and damages relating to my name, voice, likeness or any identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates my name, voice, likeness or any other identifiable representation of myself and my family. I have agreed to the above in consideration of the opportunity given to me by the Miracle League Association to appear in these materials.
Adult Volunteer Signature
Date
-----Parents/Guardians, please fill out the following additional fields if the volunteer is under 18-----
Parent Email
Parent Cell Phone
Youth Release Form (under 18) *Mandatory Section
In consideration for Miracle League of Westchester, Inc. providing the opportunity for my child to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless Miracle League of Westchester, Inc., 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 my child's activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned. I consent for my child to receive first aid and/or emergency medical care in the event of an injury.
I/We assume all risks and hazards incidental to such participation in Miracle League games and activities and consent for my child 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 my child suffers an injury during sanctioned games and activities.
Youth Volunteer Signature
Date
Parent/Guardian Signature
Date
Youth Photo Release Form (under 18) *Optional Section
I understand that there will be media and promotional coverage of Miracle League Games and activities and I give my consent to publish my/our child’s name and picture for such purposes. I hereby grant the Miracle League of Westchester, its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my/our child’s name, voice, likeness or any other identifiable representation of myself and my family members, including my child. 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). I agree that all material containing identifiable representation of my child, or 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. I hereby release and forever discharge The Miracle League Of Westchester from any and all liability and damages relating to my child’s name, voice, likeness or any identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates my name, voice, likeness or any other identifiable representation of my child, myself and my family. I have agreed to the above in consideration of the opportunity given to me by the Miracle League Association to appear in these materials.
Youth Volunteer Signature
Date
Parent/Guardian Signature
Date
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