Page 1

SALEM INTERNATIONAL UNIVERSITY – Softball Pitching Clinic Registration Form Name_____________________________________________ Grade _________________________ Mailing Address _______________________________________________________________________ ____________________________________________________________________________________ School_____________________________________________ Email _________________________ Parent/Guardian ____________________________________ Contact # ______________________ Allergies _____________________________________________________________________________ Medication Instructions if needed _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Other Concerns ________________________________________________________________________ _____________________________________________________________________________________ Other Emergency Contact Name and Number _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I __________________________ give, ________________________________ permission to participate in the Salem Pitching Clinic. I understand that an injury may occur and will not hold Salem University Responsible. In the event of an injury I give the clinic permission to care for my child within necessary means. Parent/Guardian Signature _______________________________________________________________ Date _________________________ Return to: Coach Steve Potts Salem International University 223 West Main Street Salem, WV 26426

SIU Softball Pitching Clinic Registration Form  

Salem International University