The Virginia Marlins Registration Form
Name: ____________________________________________Age ____ Birth-Date _________SSN______________
Address: _______________________________________City ________________ State _____ Zip ___________
Home Phone ______________________________ Cell Phone _______________________________________
Email Address ______________________________________________Facebook ________________________
School/College ________________________________ Class _____ Position ______ Throw ___ Hit ___
Height _____ Weight _____ 60 Speed___ Arm Speed ___ (Circle) Jersey Size: S M L XL XXL (Circle) Hat Size: S-M, M-L
HS/College GPA ______ SAT _____ Academic Interest/Major ________________________________________
Bench ____ Dead-lift ____ 40 ___ 60 ___ Vertical ___ Pro Agility ___ Velocity ___ Pull-ups ___
Virginia Marlins Registrations:
VA Marlins Spring Team ____$ 795.00
VA Marlins Summer Collegiate Teams ____$ 695.00
Va Marlins Summer High School Showcase Team ____$ 695.00
Va Marlins Summer Class A Team ____$ 695.00
VA Marlins Developmental Program Teams ____$ 595.00
($150.00 Per Month Payments for 4 months)
($40.00 per Week)
Post Graduate Academy (High School Graduates Only):
VA Sports Academy (Out of State Semester Tuition) ____ $3,500.00
VA Sports Academy (In-State Semester Tuition) ____$2,250.00
Make Checks Payable to: The Virginia Marlins
Send To: The Virginia Marlins
334 Hampton Dr., Danville, Virginia, 24540
I, _____________________________, will participate in the VA Marlins Program and will follow the rules of engagement as outlined by the coaching staff of the Virginia Marlins. 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 their behalf in the event of an emergency that involves my health and welfare. Signature: ____________________________________________ Date_______
We agree to allow our son/daughter to participate under the above conditions of the Virginia Marlins as stated, and we will not hold the Virginia Marlins, The Virginia Marlins Indoor Complex, JEB International Tobacco, Inc., or JEB Reality LLC, and all associated ownership or the Good Citizens Foundation 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. We also provide the following insurance information to be used for the care of our son in the event of an emergency.
Signature: ____________________________________________________________________ Date_____________
Insurance Company Name__________________________________ Policy Number__________________________
Address ___________________________________City _________________State ___Zip ______Phone _________