Miami Valley Open ID Showcase

Personal Information

• First Name *
  Last Name *
• Birth Date * (YYYY-MM-DD)
  Email Address *

Address

• Street *
  City *
• State *
  Zip Code *
• Home Phone *
  Cell Phone *

School Information

• School *
  Class *

  Select20122013201420152016
• Primary Position *

  Select RHP LHP 1B SS 3B C 2B/MIF OF
  Secondary Position

  Select RHP LHP 1B SS 3B C 2B/MIF OF
• Bats/Throws *

  SelectR/RL/RSwitch/RL/LR/LSwitch/L
• Height *
  Weight *
• Baseball Highlights *
  Academic Highlights *

• How did you hear about us? *
• I hereby authorize The Prep Baseball Report to act for me in judgment in any emergency requiring medical attention. I hereby waive, release and indemnify The Prep Baseball Report LLC, Prep Baseball Report & Partners, PBR Missouri LLC, PBR Pennsylvania LLC, PBR Michigan LLC, PBR Indiana LLC, PBR Ohio LLC, and Pastime Tournaments 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. *
• 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 Prep Baseball 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 Prep Baseball Report and/or its affiliates and/or sponsors for promotional purposes in any media whatsoever. *