The Rex Hudler Wonder Dog Baseball Skills Clinic

1. The Rex Hudler Wonder DogBaseball Skills Clinic When Tuesday, December 27, 2011 1pm –4pm Check in 12:30 WhereJSerra High School, San Juan Capistrano (5 freeway at Junipera Serra) Who Ages 7 – 15 years old WhatInstruction from former professional (MLB) baseball players. Attendees will spend 45 minutes at each instructional area $75 per person RSVPRegister by December 23rd by fax or email fax 949-487-0123 or email championshipbroadcasting@gmail.com Pitching Fielding Hitting Base Running Makes a great Holiday Gift! Gift Certificate To: Baseball Fan From: Admit One

2. The Rex Hudler Wonder DogBaseball Skills ClinicRegistration Form Your email: Father’s Name: Phone Mother’s Name: Phone Players' Address: City StateZip Player's Home Phone: First Player: Name Age: Birthdate: Youth Baseball League Second Player: Name Age: Birthdate: Youth Baseball League I understand that my child's picture may be taken and published (please initial) Credit Card Information: ___Visa ___MasterCard Number: Exp. Date: CVC# on back of card Signature: Checks Made Payable to: Championship Broadcasting Fax Application to: 949-489-0123 or Mail to: Championship Broadcasting 28832 Via Buena Vista San Juan Capistrano, CA 92675

3. The Rex Hudler Wonder DogBaseball Skills ClinicEmergency Medical Form Player:Date of Birth Home Phone: Parent: Cell phone: Parent: Cell phone: Family Doctor: Phone Number: Under most conditions a physician is not permitted to treat a minor without consent of a parent or legal guardian. This legal restriction is intended to protect the rights or parents or guardians, but because of it, if an emergency occurs, someone would try to contact you first. If this is unsuccessful, we need your consent to obtain emergency medical attention. Your signature below also certifies that your child has no medical problems that would prevent him/her from participating in our program. To: Rex Hudler Wonder Dog Show and Championship Broadcasting If during the course of my child’s activities at the clinic, he/she should become ill or sustain an injury, I hereby authorize you to obtain emergency medical care for (camper name) . Signature of Parent/Guardian:Date:

4. Participant release of Liability, Waiver of Claims, Express Assumption or Risk and Indemnity Agreement • Please read and be certain you understand the implications of signing • Expressed Assumption of Risk Associated with Sport, Venue Use and Related Activities. • I do herby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with participation in the Rex Hudler Wonder Dog clinic, transportation of equipment related to the activities and traveling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to: • Rick of injury from the activity and equipment utilized ins significant including the potential for broken bones, sever injuries to the head, neck and back or other bodily injuries that may result in permanent injury or death. • Possible equipment failure and/or malfunction or misuse of my own or others’ equipment • I Agree to wear protective gear (helmets). However, protective gear cannot guarantee the participants safety. I further agree that no helmet can protect the wearer against all potential head injuries or prevent injury to the wear’s face, neck or spinal cord. • Variations and/or steepness of terrain, variations or changes in surfaces including but not limited t o bare spots, rocks, stumps, debris, trees, fences, posts, light poles, signs building, roads, walkways, ramps, and any other man made or natural obstacles. • My own negligence and/or the negligence of others, including but not limited to operator error and guided decisions making including misjudging terrain, or other obstacles • Impact or collision with other athletes, spectators, facility employees or any other potential obstacles • I understand the descriptions of these risks is not complete and unknown or unanticipated risks may result in injury, illness or death • RELEASE OF Liability, Waiver of Claims and Indemnity Agreement • In consideration for being permitted to participate in the above described activities and related activities, I hereby agree, acknowledge and appreciate that” • I herby release and hold harmless with respect to any and all injury, disability, death or loss or damage to person or property. Whether caused by negligence or otherwise, the following entities, Championship Broadcasting, Rex Hudler Wonder Dog Show, The McClemmy Companies, Jserra Catholic High School it’s officers, employees and volunteers. • To release the releases, their officers, directors, employees, representatives, agents and volunteers from liability and responsibility whatsoever and for any claimed or causes of action that I my estate, heirs, survivors, executors or assigns may have for personal injury, property damage or wrongful death arising from the above activities where caused y active or passive negligence of the releases or otherwise • By entering into this Agreement, I am not rely on any oral or written representation or sttement made by the releases other that what is set forth in this agreement • This agreement shall apply to any and all injury, disability, death or loss or damage to person or property occuring at any time after the execution of this agreement. • This release shall be binding to the fullest extent permitted by law. If any provision of this releasae is found to be unenforceable the remaining terms shall enforeable • I have read this release of libility and assuption of risk, I fully understand its terms I understnt that I have given up legal rights by signing it and I sign it freely and volunitarily without any inducement • Signiture of adult or legal guardian Name of Parent or legal guardian (please print) • Name of Minor Participant