Participant’s Name:___________________________________________________

Address: __________________________________________________________

City: ________________________   State: _________     Zip Code: ___________

Guardian: ____________________________________

Home: (______)_________-_______________      Business:(_____)_________-____________

Cell:(_____)________-________________    Current League: _________________________

Participant’s Age: ___________     Birthday: __________________

Email Address:_________________________________________

MEDICAL AND LIABILITY RELEASE

>>> PLEASE READ CAREFULLY BEFORE SIGNING <<<

Please tell us of any conditions that attending physicians should be aware of:

_____________________________________________________________________________

RELEASE FOR MEDICAL TREATMENT

It is necessary for you to authorize healthcare providers (including physicians, ambulances, etc.) to administer treatment in the case of an emergency (accident, sudden illness, etc.). Therefore, this application IS NOT COMPLETE AND WILL NOT BE ACCEPTED by THE WINNING INNING, INC. until this form - signed by the Participant if of legal age or parent or guardian - has been received before the start of any program.

I hereby authorize any medical treatment which may be advised or recommended by the attending physician of the Participant while participating in any of THE WINNING INNING, INC. programs.

Sign Here _______________________________________    Date ______________________

PARTICIPANT if legal age, or PARENT/GUARDIAN Signature

The undersigned hereby acknowledges that participation in any of THE WINNING INNING, INC. PROGRAM and related activities involves an inherent risk of physical injury. Therefore, the Participant, if of legal age, parent(s), or guardian(s) hereby assume all such risk and do hereby release and forever discharge THE WINNING INNING, INC., its directors, officers, employees, and agents from any and all liability of whatever kind of nature, arising from and by reason of any and all known and unknown, forseen and unforseen bodily and personal injuries, damage of property, and consequences thereof resulting from the Participant’s active participation or involvement in any of THE WINNING INNING, INC. programs or activity for the next five years, including but not limited to, and failure of equipment or defect in premises.  Signatures:

Participant, if of legal age ___________________________________   Date ____________

I/We hereby state that I am/We are the parent(s)/legal guardian(s) of the applicant who is under legal age.

Parent(s) or Guardian(s) _________________________________   Date _______________