Midcoast Baseball Clinic in partnership with Lasell College Baseball
REGISTRATION June 18 - 22
Session 1 (Ages 8-12) 9 a.m. to Noon Session 2 (Ages 13-18) 12:30 - 3:30 p.m. Before June 1: $50 Thomaston Resident After June 1: $60 Thomaston Resident
$70 Non-resident $80 Non-resident
Make checks payable to Thomaston Recreation Mail or drop off to Thomaston Recreation 170 Main Street, Thomaston, ME 04861 CHILDS NAME: __________________________________________________________________ HOME ADDRESS: _______________________________________________________________ TOWN: ________________________________________________________________________ GRADE: ___________ AGE: __________
T-shirt size: YS YM YL AS AM AL AXL
HEALTH CONCERNS: ____________________________________________________________ PARENT/GUARDIAN NAME: ______________________________________________________ CELL: ____________________
HOME: __________________ WORK: _________________
EMAIL: _________________________________________________________________________ Emergency Contact (if parents unavailable): _____________________________________________ Emergency Contact phone: Home/Cell _______________________ Work: ____________________ I authorize Thomaston Recreation Department to publish photos / video of my son / daughter in print or online at ThomastonRec.com and in the local media outlets. YES or NO I, the undersigned, agree & understand that partaking in any of the above named activities may be hazardous and could result in injury. I certify that my child has my permission, is physically capable of participation, and I assume all risks of injury involved with any of the above activities. Furthermore, I hereby for myself, my heirs, executors and administrators, waive and release all rights & claims I may have against the Town of Thomaston, the Thomaston Parks & Recreation Department & it’s Boosters, as well as all the above named groups agents and representatives for any and all injuries suffered by me or my child in this program. I also understand it’s my responsibility to provide transportation for my children to and from the above mentioned camps/clinics & my signature indicates my agreement to arrange for drop off & pick up of my children in a timely manner. I have read and understand the above information and agree to abide by it. I understand the Thomaston Recreation Departments strongly recommend that I/ we have accident & health insurance in force when participating in any of the camps or clinics. _________________________________________________________ (Signature of parent or guardian- required for participation)
____________________ Date
Thomaston Recreation Department | ThomastonRec.com
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