Fort Wayne Open ID
2016-08-20

Personal Information

• First Name *
  Last Name *
• Birth Date * (YYYY-MM-DD)
• Email Address *
  Secondary Email (ie. Parent) *

Address

• Street *
  City *
• State *

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  Zip Code *
• Home Phone *
  Cell Phone *

School Information

• School *
  Class *

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• Primary Position *

  Select P C OF INF 1B 2B 3B SS
  Secondary Position

  Select P C OF INF 1B 2B 3B SS
• Throws *

  Select Right Left Both
  Bats *

  Select Right Left Switch
• Height *

  Select 4’0" 4’1" 4’2" 4’3" 4’4" 4’5" 4’6" 4’7" 4’8" 4’9" 4’10" 4’11" 5’0" 5’1" 5’2" 5’3" 5’4" 5’5" 5’6" 5’7" 5’8" 5’9" 5’10" 5’11" 6’0" 6’1" 6’2" 6’3" 6’4" 6’5" 6’6" 6’7" 6’8" 6’9" 6’10" 6’11"
• ACT
  SAT
  GPA
• Twitter Handle
  Summer Team *
• Shirt Size *

  Select Small Medium Large

• How did you hear about us? *

  Select Coach Friend/Teammate Parent Search Engine Social Media
• Promo Code

• Required

  I hereby authorize Fastpitch Report to act for me in judgment in any emergency requiring medical attention. I hereby waive, release and indemnify Fastpitch Report of all legal responsibilities in the event of injury to my child. I know of no mental or physical problems, which might affect my child's ability to safely participate in this camp. I will be responsible for any medical charges in connection with his/her attendance of the camp, before, during or while leaving any program. Please list any health or medical problems of registrant.

• Required

  I hereby give my full permission for the use of my name, picture, image, video, likeness, actions, voice, or other personally identifiable information, in whole or in part, individually or in conjunction with other images, captured by any means as part of my participation in any Fastpitch Report and/or an affiliate sponsored event. I waive all rights of privacy or compensation, which I may have in connection with such use of my name, picture, image, video, likeness, actions, voice or other personally identifiable information, to be used by Fastpitch Report and/or its affiliates and/or sponsors for promotional purposes in any media whatsoever.