Group Lessons - Full Circle Fastpitch

Pitcher's Name*

Age*

Birth Date*

Shirt Size*

Pitcher's Phone # (Optional)

Pitcher's Email (Optional)

School*

Grade*

Graduation Year*

Plays*

Travel Team

Parent Name(s)*

Address*

Street Address City State ZIP Code

Email*

Primary Communication

Phone*

Emergency Contact*

Emergency Contact Phone*

Please provide cell number

Social Media and Marketing Release*

Full Circle Fastpitch has my permission to use my child's photograph publicly on Full Circle Fastpitch's website and social media. I also understand no royalty, fee or other compensation shall become payable to me by reason of such use.

List Which Pitches You Have Learned*

Do you want to play college softball?*

Yes
Maybe
No

Other Information - experience, past injuries, etc

Dates | Locations | Times

Dates for Seymour (Sundays) - 1201 Strome Street

Dates for Ottumwa (Mondays and Tuesdays) - 20237 87th Street

Dates for Cuba City, WI (Thursdays) - 1121 South Cody Street

Dates for Epworth (Fridays) - 625 East Main Street

Comments

Cost | Payment

Payment Method

Hour Lesson in Seymour, Cuba City or Epworth

Price: $ 45.00

Hour Lesson in Ottumwa

Price: $ 50.00

Checks
Checks payable to: Full Circle Fastpitch
P.O. Box 84
Corydon, Iowa 50060

Authorization*

I do hereby authorize Cassandra Allen/Full Circle Fastpitch to initiate a one time entry for the amount below against my bank or credit card.

Total

$ 0.00

Credit Card*

Card Details

Cardholder Name

Waiver*

I, the parent, understand that participation in softball activities involves the risk of serious injury to my daughter. This includes, but is not limited to illness, paralysis, permanent disability, or death. I recognize softball is a physical sport and injuries can occur from the movements being performed, interaction with the other participants, or the location of the clinic. I have considered these risks and have explained these to my daughter. I agree to hold harmless Cassandra Allen against any and all claims, suits, or actions of any kind for damages as a result of any injury or loss from participation in her camp. I authorize Cassandra Allen to seek appropriate care for my daughter in the event of a medical emergency, and I agree to be responsible for the cost of such care. I understand and agree to these conditions.

Policies

Cancellation Policy
Must cancel within 5 hours, otherwise, payment is owed for the lesson.

Refund Policy
No refunds – can be used for credit for future lessons/camps if notified within the 5-hour cancellation policy.

Returned Check/Payment
There will be a $35 charge for any returned check or returned payment. Please make sure to notify me of new credit card expiration dates if necessary during the year.