Please print out this form and when filled out or prior to involvement in a Stods program 
you will need to present this form to validate your participation.
Team/Coaches name and age level  ________________Telephone #___________
Name of Player: ___________________age of player_______ Birthdate _________
Mailing Address: _________________________________________________________
City: _______________________Zip: ___________
Accident insurance: 
I waive and release Stods Baseball Inc and Eastside Baseball Association from all 
liability from any injury or sickness while playing for Stods baseball teams and all 
Stods Baseball programs/activities. I hereby give my permission for emergency 
medical treatment in the event I cannot be reached. All participants must provide 
proof of insurance coverage for any injury or sickness while playing for Stods baseball teams.
  
Release of liability: I authorize Stods Baseball Inc., Eastside Baseball Association 
and it's employees to act for me in an emergency  requiring medical attention. 
I understand I am responsible for all hospital, laboratory,  dental, and doctor's fees. 
My child is physically fit to participate in vigorous physical activity.
I further understand that Stods Baseball Inc and its associates  will not be held 
responsible for accidents or illnesses. I hereby give my permission for my child 
to participate on Stods Baseball teams, Eastside Baseball Association teams and all 
Stods Baseball and Eastside Baseball Association programs/activities. 
I represent that my child is physically able to participate and I further 
acknowledge that there are certain risks of injury inherent in the participation 
of any sport and that such an injury my occur. I hereby release and discharge 
Bob Stoddard, Stods Baseball Inc., Eastside Baseball Association and any of its 
employees from  any and all liability, claims, demands, causes of action, 
of any sort arising from any injury sustained by my child consequent of his 
participation on Stods Baseball,  Eastside Baseball Association teams
 and all Stods Baseball and Eastside Baseball Association programs/activities. 
By signing this form for registration I hereby acknowledge I have read the 
above liabilities and accept the terms and conditions as outlined under 
Accident insurance and Release of liability.  
Parents Name Print: ______________________Relationship to Player: _____________________
Signature: ____________________________
Your Insurance company: _________________Policy Number: ___________________________