SIU Softball Pitching Clinic Registration Form
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
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Salem International University
Transcript of SIU Softball Pitching Clinic Registration Form
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
