PLAYER NAME *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

PARENT NAME *

First Name

Last Name

CONTACT NUMBER *

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ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

ADDITIONAL CONTACT

First Name

Last Name

ADDITIONAL CONTACT PHONE NUMBER

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Authorization for Medical Care *

On behalf of myself and the participant, I acknowledge and agree as follows: I am the parent or legal guardian of the participant. The participant is capable of safely participating in the related activities, and all activity restrictions, allergies, and medications applicable are listed in the forms above. In the event of an emergency or non-emergency situation requiring medical or dental treatment, I hereby grant permission to staff for any and all medical or dental care to be administered to the participant, including, but not limited to, the administration of first aid, the administration of an epinephrine auto-injector, and the use of an ambulance. I also hereby authorize staff, acting as my agent, to consent to the following for the participant: (i) any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician or surgeon licensed in the state, county, or other locality where the physician or surgeon is located, or (ii) any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed in the state, county, or other locality where the dentist is located, or (iii) the foregoing in clauses (i) and (ii) administered or performed by the staff of any acute general hospital holding a current license to operate a hospital in the state, county, or locality where it is located. I understand that a good faith attempt will be made to contact me, or the emergency contact named above, before consenting to any of the foregoing in clauses (i), (ii) or (iii) above. I understand that this authorization is being given in advance of any specific diagnosis, treatment, or hospital care being required, and is given to provide authority and power to staff to give specific consent to any and all such diagnosis, treatment, or hospital care which an aforementioned physician, dentist, or staff in the exercise of his or her best judgment may deem advisable. I understand that it is important that Hollister Elite have my permission to share the medical care and emergency contact information of the participant with the involved staff. My acknowledgement below authorizes these individuals to access the participant's medical and emergency records and to share this information with involved staff or emergency medical personnel, hospital, or other health care professional who evaluates, diagnoses, or treats an injury, illness, or other condition incurred by the participant, as deemed necessary by staff. I understand and acknowledge that I am responsible for, and agree to fully pay, all costs of medical and/or dental care incurred by the participant and rendered pursuant to the authorizations given in this Authorization for Medical Care, including, but not limited to, the cost of medical evacuation, paramedic transportation, hospitalization, and any examination, x-ray, or other treatment provided pursuant to the authorizations given in this Authorization for Medical Care. I further understand and agree that my insurance is primary and non-contributory to any insurance that Hollister Elite Baseball and/or the property owner may carry. I hereby, on behalf of myself and the participant, release, forever discharge, and will hold harmless Hollister Elite Sports, and the owner of the facility (and their respective directors, officers, employees, officials, affiliates, sponsors, hosts, agents, assigns, subsidiaries, owners, partners, and joint venturers) (collectively, the “Released Parties”) from and against any and all claims, actions, demands, rights, causes of action, losses, liabilities, costs and expenses, including attorneys’ fees (“Claims”), arising from or in connection with any medical or dental aid rendered to the participant, including any Claims arising out of the passive or active negligence or any other act or omission by the Released Parties. I further agree to indemnify, defend, and hold the Released Parties harmless from and against (i) any claim by a medical or dental care provider or insurance coverage provider for the cost of medical or dental care provided to the participant and (ii) any medical or dental bills paid by a Released Party on the participant's and/or my behalf. I acknowledge that I have carefully read the above Authorization for Medical Care, and that I understand its contents. By checking I Agree, I hereby agree to the Authorization for Medical Care.

I AGREE

Release of Liability and Indemnity *

In consideration of the player participating in the related activities, and as a condition thereof, I am signing this Release of Liability and Indemnity (this “Release”) on behalf of myself and the player. This Release is made in favor of Hollister Elite Sports and the owner of the facility at which the activities are operated (and their respective directors, officers, employees, officials, affiliates, sponsors, hosts, agents, assigns, subsidiaries, owners, partners, and joint venturers) (collectively, the “Released Parties”). On behalf of myself and the player, I acknowledge and agree that: The risk of injury and/or loss from participating in activities is always present due to the nature of the activities, regardless of the care used, the skill or experience possessed, or the precautions taken by me, the player or anyone else, including any of the Released Parties. I am aware that participation can cause physical and/or psychological injury, including, but not limited to, serious permanent bodily injury, paralysis, illness and/or death to the player or others, and/or damage to my, the player's or others’ belongings. The player and I voluntarily elect, with knowledge of the risks involved, for the player to participate in all activities. Participating may expose the player to contagious diseases, such as, for example, coronavirus (COVID-19), influenza, and the common cold. These diseases spread easily through person-to-person contact, and may be spread by persons who are not exhibiting any symptoms. These diseases can lead to severe illness, personal injury, permanent disability, and death. Participating increases the risk of becoming infected and/or ill. I acknowledge and agree that such risks are part of the risks and hazards that the player and I assume and release as set forth in this Release. I knowingly and freely accept and assume all risks, damages, and hazards associated, directly or indirectly, with the player's participation, whether known or unknown, whether caused by the action, inaction, or active or passive negligence of me, any of the other Released Parties, or otherwise. I agree not to make a claim against or sue the Released Parties for, and I release, forever discharge, and will hold harmless the Released Parties, and each of them, from and against any and all claims, actions, demands, rights, causes of action, losses, liabilities, costs and expenses, including attorneys’ fees, arising from or in connection with any injury, disability, illness, death, or loss or damage to person or property that may be sustained or suffered by me, the player, or by any other person as a direct or indirect consequence of the player's participation, whether caused by the action, inaction or active or passive negligence of me, the player, any of the Released Parties, any third parties, or otherwise; provided. I hereby agree to indemnify, defend and hold harmless the Released Parties, and each of them, from and against any and all losses, damages, liabilities, judgments, penalties, fines, costs and expenses, including attorneys’ fees, arising out of or in connection with any third party claim that arises out of or relates to the player's participation in. I understand and agree that I am responsible for any and all damages, losses, and expenses incurred by a Released Party arising out of or related to the player's conduct. If I have any concerns regarding the player's readiness for participation, I will remove the player from participation and bring such concerns to the attention of the facility staff immediately. If any term or provision of this Release is determined to be illegal, unenforceable, or invalid in whole or in part for any reason, such provision shall not affect the legality, enforceability, or validity of any other provision of this Release and such provision shall be reformed and construed so that it will be legal, enforceable, and valid to the maximum extent permitted by law. This Release will survive the completion of the player's participation and will continue in full force and effect thereafter. I have read this Release carefully and fully understand all its terms and provisions. I have knowingly and voluntarily agreed to this Release understanding the risks to me and the player and have done so of my own free will, without relying on any statement or representation of any of the Released Parties. I understand that this Release is the entire agreement between me and the Released Parties with respect to the subject matter hereof and that that this Release cannot be modified or changed in any way by oral statements by any of the Released Parties or by the player or me. I understand that, in the event of any litigation against the Released Parties, this Release may be raised as a defense and bar to, and as a waiver and release of, legal rights that might otherwise be asserted by me, the player, or any of my or the player's heirs, assigns, personal representatives or survivors. I acknowledge that I have carefully read the above Release of Liability and Indemnity, and that I understand its contents. By checking I Agree, I hereby agree to the Release of Liability and Indemnity.

I AGREE

Acknowledgement of Information Provided *

I hereby represent, to the best of my knowledge, that the information provided in the sections above is accurate. Without limiting the terms of these Health and Release Forms and Rules and Regulations, I understand that information I provide to Hollister Elite Sports, whether pursuant to these Health and Release Forms and Rules and Regulations or otherwise, is governed by Hollister Elite Sport's privacy policy, and I agree to Hollister Elite Sport's privacy policy, as it may be amended from time to time in accordance with its terms. By checking I Agree, I hereby agree to the above agreements and releases, and to be legally bound thereby.

I AGREE

Media Release *

I understand that the player may be photographed, filmed, videotaped, or otherwise recorded, and I grant, permission to Hollister Elite Sports for my child's participation. I hereby grant permission to Hollister Elite, to use, including to display publicly or to perform, the above-named minor’s image, likeness, or voice recording on the Hollister Elite's website or in any other official Hollister Elite publications without further notice or compensation.

I AGREE

Acknowledgment of Participation *

I acknowledge that my child's participation in any activities at The Barn baseball training facility, are in no affiliation with Hollister Little League.

I AGREE