2013 Reagan Softball Academy September 16, 19, 23, 26, 30 October 3, 7, 10, 14, 17 4:00 to 6:00 pm Ray Chandler Softball Field Reagan High School REGISTRATION _________________________________________________ Name _________________________________________________ Grade/Age/Date of Birth _________________________________________________ Parent/Guardian Name _________________________________________________ Address _________________________________________________ City _________________________________________________ Telephone/Cell Numbers ______________________________________________________ ______________________________________________________ Current School _________________________________________________ Hoodie and T-Shirt Sizes Academy Cost: $75 Please register as soon as possible. Please return registration information and check payable to: Reagan Softball Contact Information: Bob Berlinger Reagan High School 3750 Transou Road Pfafftown, NC (336) $75 Academy open to current 7 th through 12 th graders.

Coaching Staff: Mike Stigall – Head JV Softball Coach at Reagan High School Mandy Gupton – Assistant Softball Coach at Reagan High School Mark Cummings – Assistant Softball Coach at Reagan High School Mandy Walker – Assistant Softball Coach at Reagan High School AGREEMENT/RELEASE I,___________________________, am the parent or legal guardian for _______________________. I fully understand and appreciate the potential dangers, hazards and/or risks, directly and/or indirectly inherent in participating in this activity, which could also include loss of life, serious loss of limb, or loss of property. In consideration for being allowed to participate in this activity, I agree to hold harmless the supervisor(s) and coordinator(s) of this activity, Reagan Softball, its agents, officers, employees, and student volunteers harmless for any and all direct, indirect, special or consequential damages, costs, legal and otherwise, which I may incur as a result of my participation in this activity, even if due to the reasonable negligence of any person serving in the above identified capacities. I have read the terms of this Agreement/Release and I understand and voluntarily agree to the terms and conditions. This Agreement/Release shall be binding upon heirs, administrators, executors, and the assigns of the undersigned. ____________________________________ Participant Signature ____________________________________ Parent/Guardian Signature ____________________________________ Insurance Company and Policy # ____________________________________ Emergency Contact and Telephone # ____________________________________ Hospital Preference Any allergies or medical conditions that the staff should be aware of? _____Yes_____No If Yes, please describe: __________________________________________________________ __________________________________________________________ __________________________________________________________ What to Bring? Pants, Shirt, Spikes, Glove, Batting Gloves, Bat, and Helmet. Academy Goal To provide the optimal learning environment in which every student athlete can improve their softball skills.