2013 Reagan Softball Academy

September 16, 19, 23, 26, 30

October 3, 7, 10, 14, 17

4:00 to 6:00 pm

Ray Chandler Softball Field

Reagan High School

REGISTRATION

_________________________________________________Name

_________________________________________________Grade/Age/Date of Birth

_________________________________________________Parent/Guardian Name

_________________________________________________Address

_________________________________________________City

_________________________________________________

Telephone/Cell Numbers

______________________________________________________

Email

______________________________________________________

Current School

_________________________________________________Hoodie and T-Shirt Sizes

Academy Cost: $75Please register as soon as possible.

Please return registration information and check payable to:

Reagan SoftballContact Information:

Bob BerlingerReagan High School3750 Transou Road

Pfafftown, NC 27040(336) 703-6776

rjberlinger@wsfcs.k12.nc.us$75

Academy open to current 7th through 12th graders.

Coaching Staff:Mike Stigall – Head JV Softball Coach at Reagan High School

Mandy Gupton – Assistant Softball Coach at Reagan High School

Mark Cummings – Assistant Softball Coach at Reagan High School

Mandy Walker – Assistant Softball Coach at Reagan High School

AGREEMENT/RELEASEI,___________________________, am the parent or legal guardian for _______________________. I fully understand and appreciate the potential dangers, hazards and/or risks, directly and/or indirectly inherent in participating in this activity, which could also include loss of life, serious loss of limb, or loss of property. 

In consideration for being allowed to participate in this activity, I agree to hold harmless the supervisor(s) and coordinator(s) of this activity, Reagan Softball, its agents, officers, employees, and student volunteers harmless for any and all direct, indirect, special or consequential damages, costs, legal and otherwise, which I may incur as a result of my participation in this activity, even if due to the reasonable negligence of any person serving in the above identified capacities.

I have read the terms of this Agreement/Release and I understand and voluntarily agree to the terms and conditions. This Agreement/Release shall be binding upon heirs, administrators, executors, and the assigns of the

undersigned. 

____________________________________Participant Signature

____________________________________Parent/Guardian Signature

____________________________________Insurance Company and Policy #

____________________________________Emergency Contact and Telephone #

____________________________________Hospital Preference

Any allergies or medical conditions that the staff should be aware of?

  _____Yes _____No

If Yes, please describe:______________________________________________________________________________________________________________________________________________________________________________

What to Bring?Pants, Shirt, Spikes, Glove, Batting Gloves, Bat, and Helmet.

Academy Goal To provide the optimal learning environment in which every

student athlete can improve their softball skills.