2010 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 _________________________________________________   

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