Fundraiser Softball Camp

Southern Union
Softball Fundraiser
All Skills Camp

September 21, 2024

Location: Alexander City Charles Bailey Softball Sportsplex
Cost: $75 per player
Ages: 6 - 18

Address: 1685 Arena Rd, Alexander City, AL 35010

Name of Person Attending:*

First NameLast Name

Position:*

Age:*

School:*

Travel Ball Team:

Phone Number:*

Please enter a valid phone number.

Email:*

example@example.com

Hit:*

RightLeftBoth

Throw:*

RightyLefty

Parent Contact:*

First NameLast Name

Phone Number:*

Please enter a valid phone number.

Emergency Contact:*

First NameLast Name

Emergency Contact Number:*

Please enter a valid phone number.

SU Medical Release Form

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Southern Union Athletics during the selected camp. In exchange for the acceptance of said child’s candidacy by Southern Union, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Southern Union, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Southern Union, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Southern Union and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

I acknowledge that I have read the above medical release statement.

Name:*

First NameLast Name

Date*

Date

Signature:*

This softball camp is a fundraiser for the Southern Union Softball Program. Funds from this camp will go to directly to the purchase of a new pitching machine and screens for the softball program. If you cannot attend but would like to donate to this fundraiser, please see payment information below.

Payment Information

Cost is $75 per person. You can use the following payment options:

Cash App:
Christina Steiner
$CS14sportstraining

VENMO:
Christina Steiner @CS_Sports_Training

If you have any questions please contact Christina Steiner-Leak at csteinerleak@suscc.edu.