Panther Pipeline Registration Form  Logo
  • A 5 week program tailored to players wanting to get to the next level.

    Cost $150

    Register early as spots are limited!

    Click here for program details

  • Athlete Information

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  • Parent/Guardian Information

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    • Add another parent/guardian 
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    • Emergency Contact & Health Information

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    • Permissions and Consent

    • By signing and submitting this form I give consent that in the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to the nearest medical facility or the facility recommended by the responding personnel.


      I give consent for the facility to secure any and all necessary emergency medical care for my child.

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    • Release of Liability

    • Although the safety of all sport activities is the primary concern, sport activities may cause injuries and/or death.  By signing and submitting this form I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against KMBA and the persons in charge.
    • By submitting this form I agree to the following conditions:

      I agree to abide by the KMBA Code of Conduct and understand that violation of the code of conduct may result in your removal from the program.  This agreement holds true for the player and other parents/guardians included on this form.

      I grant permission to the Kitchener Minor Baseball Association (KMBA) to use name and limited personal information of the child indicated on this form, and also team and action photographs including their child, in print and in electronic media. Such photographs may be used by KMBA in all formats and publications including, but not limited to, newspapers, brochures and the websites of KMBA for publicity purposes. Electronic media may also include individual player stats, game and team information. No other personal information (example: address, phone number, school) will be disclosed. KMBA is committed to protecting the privacy of your personal information. The Undersigned understands that once a photograph is posted on a website, the image can be downloaded by any computer user and specifically waives his/her rights and protection pursuant to the provisions of the Personal Information Protection and Electronic Documents Act. 

      I allow KMBA to use contact information for future communications.  KMBA gathers information solely for the purpose registration to determine eligibility of registrant to a particular level. KMBA assures all parents that it will not use the information gathered for purposes other than those required in the administration of the association.  If you wish to unsubscribe from communications you will be given the opportunity to do so.

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