Baseball Senior All Star Acceptance | Mississippi Coaches Association: Online Forms

PLAYER AGREEMENT

Name (as you would like it to appear in the Program Book)*

First Last

Agreement*

I accept the invitation to play in the 2024 All-Star Baseball Games to be played Tuesday, May 28 through Thursday May 30, 2024.

I agree to follow all rules and regulations set forth by the Crossroads Diamond Club, Inc., and the host college. I understand by accepting this invitation that I also accept the responsibility which goes along with the honor. This includes meeting all deadlines, reporting on time, and supporting the program by selling the determined amount of advertising.
I will not be able to participate in the 2024 All-Star Baseball Games.

I will be playing for:*
NORTH
SOUTH

Class*
1A/2A
3A/4A
5A/6A/7A

Do you have a current physical on file with your school*
Yes
No

PLAYER PERSONAL INFORMATION

High School*

Mailing Address*
Street Address City State ZIP Code

Home Phone*

Cell Phone*

Player Email*

ACT Score*

GPA*

High School Coach*
First Last

Name of Counselor
First Last

Phone*

SIZE INFORMATION

Height*

Weight*

Uniform #*

Batting Average*

T-Shirt Size*

Shorts Size*

Hoodie Size*

Honors

Please list all honors received in sports and other school activities, and be specific. List the honor and the year, and if the award is not from your school, list the organization giving you the award and the name of the award (i.e., Hattiesburg Optimist Club Student of the Year, 2023).

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Honor

Year

Have you signed with a Community College or University?*
Community College
University
Neither

Name of Community College or University?*

Where do you plan to attend college?*

What do you plan to major in at college?*

CONSENT TO MEDICAL TREATMENT

Player Name*
First Last

Date of Birth*

Age*

Parent/Guardian #1*
First Last

Parent #1 Email*

Parent/Guardian #1 Cell*

Parent/Guardian #2
First Last

Parent #2 Email

Parent/Guardian #2 Cell*

Family Physician*
First Last

Physician Office Phone (including area code)*

I/We am/are the athlete's*
Parent(s)
Guardian
Conservator

Part I*
I/We am/are the parent(s) of the athlete listed above and state that he/she has no guardian or conservator appointed by law.

Part I*
I/We am/are the guardian/conservator of the athlete listed above as appointed by law.

Part II*
I/We in the same capacity as indicated in Part I authorize the Crossroads Diamond Club to take whatever medical steps are deemed necessary in case of injury and/or illness (including giving authorization to duly qualified medical personnel to administer such medical or surgical treatment to include anesthetics and/or drugs as the duly qualified medical personnel deem necessary in the diagnosis and treatment) of the athlete listed above during his participation in the 2024 All-Star Baseball Games from May 28-May 30, 2024. Treatment of any such injury and/or illness shall begin immediately upon its discovery.

Part III

Insurance Coverage*
The Above named participant is covered by hospitalization insurance.
The Above named participant is not covered by hospitalization insurance.

Policy #:*

Name of Insurance Company*

Address of Insurance Company*
Street Address City State ZIP Code

If Group Policy, give Employer

Group #

In case of emergency, Game Committee is authorized to:*
Call above named doctor
Call team doctor if family is not available
Take athlete to local hospital
Other

Please explain "Other"

Does your son/daughter have any Unusual Health Conditions:*
Diabetes
Heart Condition
Convulsive Seizures
Allergies
Other
None
Select all that apply:

'Other' Please list:

Please list Allergies:

PLAYER GENERAL RELEASE

We, the undersigned parent(s) or legal guardian(s) of the player listed above (hereinafter “Player”), a member of the Crossroads Diamond Club’s 2024 D.M. Howie Mississippi High School All-Star Baseball Team, for in the consideration of our son participating in such game and do hereby release the Crossroads Diamond Club, its officers, directors, members and any other agents or representatives (hereinafter “Releasees”) and hereby hold harmless the Releasees against any and all claims, causes of action, demands, costs, expenses, or any other potential actions asserted arising out of or in any way related to or connected with the participation of our son in the Crossroads Diamond Club’s 2024 D.M. Howie Mississippi High School All-Star Baseball Games. We, the undersigned, release the Releasees from any and all claims that may result either from the participation in practices leading up to the Crossroads Diamond Club’s 2024 D.M. Howie Mississippi High School All-Star Baseball Games or participation in the game, and transportation to or from the game and/or transportation during the week of the game. Moreover, we do hereby grant permission to the Crossroads Diamond Club to transport and entertain the above named player during the All-Star week beginning Tuesday, May 28 until Thursday, May 30, 2024, at the close of the All-Star activities. We, the undersigned, release the above named parties, their agents, employees and other related persons, including all other Releasees, from any and all claims which may result from the travel and entertainment of the above named player.

We also agree that the released parties shall not be responsible for any illness, disease, injury or other occurrence suffered by the player associated with his travel, entertainment, participation in practice or in the game, and furthermore agree that there shall be no liability to the Releasees herein for any of the above noted acts.

By these presents and in consideration above enumerated, we further covenant and agree that we shall forever refrain from instituting any action, pressing, collecting or in any way aiding or proceeding upon any and all claims, causes of action, suits and proceedings of any kind at law or in equity which our son or the undersigned ever has, or may have, against any of the Releasees herein arising out of the aforesaid activities, and more particularly participation in practices and the game relating to the Crossroads Diamond Club’s 2024 D.M. Howie Mississippi High School All-Star Baseball Games, or any other activity relating thereto.

Acknowledgement*
WE ACKNOWLEDGE THAT WE HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND WE SIGN THE ABOVE AND FOREGOING OF OUR OWN FREE ACT.

SIGNATURES

Date

Player Signature*

Parent #1 Signature*

Parent #2 Signature

Guardian Signature*

2024 Baseball: Senior All-Star Acceptance

PLAYER AGREEMENT

PLAYER PERSONAL INFORMATION

SIZE INFORMATION

Honors

CONSENT TO MEDICAL TREATMENT

Part III

PLAYER GENERAL RELEASE

SIGNATURES