Visalia Miracle League Volunteer Registration

SECTION 1: TO BE COMPLETED BY VOLUNTEERS 18yrs OR OLDER

First Name: Last Name: Gender:

Mailing Address: City: Zip:
Home Phone: Emergency Phone:

Email Address

Are you 18 years or older? If no, list your age: Drivers License #:

How would you like to participate? Check one
Buddy Substitute Buddy Coach Asst. Coach Team Parent

Special Requests:

SECTION 2: TWO RELEASE FORMS TO COMPLETE BELOW
In order to participate you must read and agree with the following releases. Your registration will not be complete unless doing so.

FORM #1 MEDIA RELEASE

MEDIA RELEASE
I hereby grant the Miracle League of Visalia, 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 or my family members including my Miracle League dependent. These materials may appear
in any form, style. Color or medium whatsoever (including photographs, videotapes, films, sound recording, software, drawing,
prints, broadcast, internet, and electronic media.) I agree that all material containing and identifiable representation of m
dependent shall be and remain the sole and exclusive property of the Miracle League of Visalia. I hereby release an forever
discharge the Miracle League of Visalia from any and all liability and damages relating to the use of my dependents name, voice
and any other identifiable representation of me. I have agreed to the above in consideration of the opportunity given to my
dependent by the Miracle League of Visalia to appear in these materials. I acknowledge that I have fully read and understand this document.
I certify that I am at least 18 years of age.

I agree with Media Release?: Yes No
Your Name:
Printing your name here indicates an electronic signature and that you have submitted it to the Visalia Miracle League.

FORM #2 VOLUNTEER ( adults 18yrs and older) RELEASE

RELEASE AND INDEMNIFICATION AGREEMENT ( ADULT VOLUNTEERS)

I hereby certify that I am over the age of 18 years. In consideration for the Miracle League of Visalia, Inc. (“Miracle League”)
providing me the opportunity to participate in Miracle League baseball, I hereby release Miracle League from any claims that I
may have now or in the future, or damage or injury that I may suffer as a result of my participation in the Miracle League
baseball. In addition, I hereby agree to indemnify, defend and hold Miracle League and it’s officers, directors, volunteers,
agents, contractors, supporters or any other person associated with the Miracle League harmless from any and all claims for loss,
damage (including attorneys fees and costs, including, but not limited to experts and consultants fees), liability, death or injury to
the person or property arising from or related to my participation in Miracle League baseball.

I assume all risks and hazards involved in, or incidental to, my participation in Miracle League games and activities and hereby
consent to receive first-aid and/or emergency care by a qualified Emergency medical Technician or physician in the event of any
injury during Miracle League games or activities.

I agree with this Release Agreement?: Yes No
Your Name:
Printing your name here indicates an electronic signature and that you have submitted it to the Visalia Miracle League.

By clicking on Submit you are submitting this document as if you were submitting a registration form signed by you to the Miracle League office for the purpose of registration.

After you click on submit you will be directed to the payment page where you will receive instructions
of how you can pay the fee. Please note your Miracle League registration will not be complete until
you pave made the payment for the registration fee.

Need to see the payment page before submitting this form? Click here.