NAME __________________________ DATE OF BIRTH _

STREET ADDRESS _________________________________________________

CITY & ZIP CODE _________________________________________________

PHONE NUMBER _________________ LEAGUE ______________________

I hereby give permission for my child to utilize the Vincennes Cub League Hitting Facility and release any and all rights and claims for damages or injuries I may have against the Vincennes Cub League, Inc., its officials and the City of Vincennes. In addition, I have reviewed and will follow the Hitting Facility rules.

MEMBER/PARENT SIGNATURE___________________________________

(if under 18 years of age)

DATE _____________________ PAID $50----yes or no (please circle)

NAME __________________________________ DATE OF BIRTH _________

MEMBER/PARENT SIGNATURE___________________________________

NAME __________________________ DATE OF BIRTH _