Liability and Medical Release Form

This completed and signed document is required for each player before
they are assigned to a team.

Name of sponsoring organization:

     Rockdale Christian Youth Softball / Bethel  
                                                                                                                                 

Address of organization:

     1930 Bethel Rd., NE,  Conyers, Ga. 30012      
                                                                                                                                 

Name of sponsor's coordinator:

     Bethel Christian Church (staff and volunteers)      
                                                                                                                                 

Description of Activity:

     Youth Softball Program - Boys and Girls      
                                                                                                                                 

Date(s) and Location of Activity:

     August 1st - October 31st, 2010 @ Bethel Christian Church / Bethel Park
Participant Information - TYPE IN YOUR INFORMATION BEFORE PRINTING
Name of participant: 
Address:            Telephone: 
Name of emergency contact: 
Telephone (daytime):        Telephone (evening): 
Is sponsor authorized to approve medical treatment?                     yes       no                      
Is participant covered by personal / family medical insurance?             yes         no                      
If yes, name of insurer: 
Policy or Group Number:  
Participation Agreement
In consideration for the opportunity to participate in RCYS / Bethel Christian Church’s Youth Softball League, the Participant (or parent / guardian in Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The Participant (or parent / guardian) accepts personal financial responsibility for any injury sustained during the activity or during transportation to and from the activity. Further, the Participant (or parent / guardian ) promises to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Sponsor”) for any injury related directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the Sponsor or otherwise.
If a dispute over this agreement or any claim for damages arises, the Participant (or parent / guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent / guardian) and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution. 
Signature:    Date:   

Print then sign this form.  BRING IT to EVALUATIONS with you to expedite the process at Evaluations.