2008 NEEDHAM GIRLS SOFTBALL
UMPIRE REGISTRATION
Name ______________ ______________Mom/Dad _______________________________
Address _______________________________________ Telephone ___________________
Birth Date ____________ School _______________ Grade _____ Your 2006 Team __________
Email addresses (will be your primary contact - print clearly) ____________________________
Emergency Contact _________________________________ Phone ________________
Other Spring Evening Activities _________________________________________________
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Please indicate your anticipated availability (and weekday evening conflicts) here:
INJURY WAIVER AND INDEMNITY
In consideration of the acceptance of this registration, I hereby release the Needham Girls Softball program and any and all of its volunteer, coaches, and umpires from any and all claims which may arise from injuries to my daughter in the course of her participation in the Needham Girls Softball program. I agree to indemnify, defend, and hold harmless the Needham Girls Softball program and any of its volunteer, coaches, and umpires from and against any and all claims which may be brought by or on behalf of my daughter for personal injuries arising out of her participation in the Needham Girls Softball program. I hereby certify that my daughter is in good physical health, and there are no health related reasons why she should not participate in the Needham Girls Softball program. Also, it is my understanding that medical insurance coverage is NOT provided by the Needham Girls Softball.
Signed: _________________________________ Date: _________________
(Signature of parent or legal guardian)
Voluntary Needham Field of Dreams Donation - Memorial Park & DeFazio ($10 suggested)_______________
Mail to: Needham Girls Softball by March 30th, C/O Laurie DiBella 76 Powers St. Needham, MA 02492 by March 1, 2007