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2019 VM Register Form


VMarlins' Player Registration

Name ________________________________________________Cell _______________________________
Parent Name __________________________________________Cell ______________________________
Address: ________________________________________________________________________________
City: _____________________________________________State:____ Zip: __________________________
School/College: ___________________________________________________________________________
Selected 2019 Program:

Summer Fee                   Due May 15, 2019                          $  850.00 __________________
            
Fall Fee                            Due September 15, 2019              $  450.00 __________________
            
2019 Total Fee                                                                          $1350.00 __________________

VMarlins international Tour Due March 15, 2019              $1450.00 __________________

Payment Options:
S
end Check to:                VMarlins, 133 Briarcliff Lane, Danville, Virginia, 24541

Make Payable to:            VMarlins

 Pay via PayPal:                Send to gmvmarlins@yahoo.com              Note: Registration fee for 2019 

 Pay with Credit Card:    Card Name: _______________________________________________________
                                          
Type of Card: ______________________________________________________
                                          
Card Number: ______________________________________________________
                                          
Expiration Date:__________________________  Security Code: _____________

Player and Family Participation Agreement

I, __________________________, will participate in the WBL Tryouts/Events and will follow the rules of engagement as outlined by the coaching staff of the WBL. I understand that I may be dismissed from participation should I conduct my actions in a manner that is not acceptable to the protocol of the program.  I also have the permission of my family to allow the coaching staff to act on my behalf in the event of an emergency that involves my health and welfare.

 Signature: ______________________________________________ Date_______________


Player and Family Medical Insurance Information Agreement

I/We agree to allow myself/our son/daughter to participate under the above conditions of the WBL as stated, and do not hold the WBL liable for any accident, injury, or other liability that results from participation.  We are personally accountable for our entrance into the facilities and we participate in the programs at our own personal risk. I/We also provide the following insurance information to be used for the care of myself/our son/daughter in the event of an emergency.  Signature: ____________________________Date__________

Insurance Company Name _________________________________________________________________
Policy Number___________________________________________________________________________
Address ________________________________________________________________________________
City ______________________________________State ____Zip ______Phone ______________________




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