Post by Jarvis on Dec 18, 2009 21:14:31 GMT -5
This form is attached as a PDF please login to download it.
Youth Sports Registration________________
Childs name:_________________________ Age/Grade_____/_______
Male__ Female__ Date of Birth:_____________
Height: (7/8 grade boys)___ Skill Level: Beginner Intermediate Advanced
Daytime Phone: ( ) _________________Evening Phone: ( ) ___________________
Street Address: ______________________________________________
City:____________________ Zip: _____________
Special Requests (request are not guaranteed):
________________________________________________________________________
Parent/Guardian Names:
________________________________________________________________________
Email Address:
________________________________________________________________________
Emergency Contact (other than household): ____________________________________
Everyone is Welcome: Greater Levels is an organization open to all people.
Financial Assistance: If you cannot afford the full cost of a program, please see Miguel or Jarvis. Financial assistance, to the extent possible is available to those in need.
Insurance: It is the responsibility of every individual, their parent or legal guardian, to provide for their own accident and health coverage while participating in all Greater Levels activities. Greater Levels does not provide any such coverage for its participants.
Prayer before games: I understand that prayer to God will be said before every game without question.
Photograph Permission: I hereby give permission for Greater Levels to use any pictures of my child for future promotional purposes.
Medical Treatment: I hereby give permission for my child to be given CPR and first aid treatment by a qualified staff member of Greater Levels. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray, examinations, transfusions, injections, drugs) to be performed for my child by a licensed physician or hospital selected by Greater Levels director when deemed immediately necessary or advisable by the physician to safeguard my child’s health.
Release from liability: recognizing that Greater Levels will do its best to ensure a safe experience, I understand that accidents may occur both from my child’s participation in youth sports activities and from transportation to and from the program. I agree to assume these risks. By signing below, I release Greater Levels, its employees, volunteers, independent contractors, directors, and agents based on any damage, loss or injury whether it is the result of ordinary negligence or otherwise, caused to my child or to me, from participation in the youth sports program.
I have read and understand the above and have completed this form to the best of my ability. I also support the Greater Levels youth sports philosophy, which is based on participation, fun, physical fitness, and health, skill development, team work, fair play, family involvement and volunteer leadership.
Signature of Parent or Guardian:
_____________________________________________________________________________________
Youth Sports Registration________________
Childs name:_________________________ Age/Grade_____/_______
Male__ Female__ Date of Birth:_____________
Height: (7/8 grade boys)___ Skill Level: Beginner Intermediate Advanced
Daytime Phone: ( ) _________________Evening Phone: ( ) ___________________
Street Address: ______________________________________________
City:____________________ Zip: _____________
Special Requests (request are not guaranteed):
________________________________________________________________________
Parent/Guardian Names:
________________________________________________________________________
Email Address:
________________________________________________________________________
Emergency Contact (other than household): ____________________________________
Everyone is Welcome: Greater Levels is an organization open to all people.
Financial Assistance: If you cannot afford the full cost of a program, please see Miguel or Jarvis. Financial assistance, to the extent possible is available to those in need.
Insurance: It is the responsibility of every individual, their parent or legal guardian, to provide for their own accident and health coverage while participating in all Greater Levels activities. Greater Levels does not provide any such coverage for its participants.
Prayer before games: I understand that prayer to God will be said before every game without question.
Photograph Permission: I hereby give permission for Greater Levels to use any pictures of my child for future promotional purposes.
Medical Treatment: I hereby give permission for my child to be given CPR and first aid treatment by a qualified staff member of Greater Levels. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray, examinations, transfusions, injections, drugs) to be performed for my child by a licensed physician or hospital selected by Greater Levels director when deemed immediately necessary or advisable by the physician to safeguard my child’s health.
Release from liability: recognizing that Greater Levels will do its best to ensure a safe experience, I understand that accidents may occur both from my child’s participation in youth sports activities and from transportation to and from the program. I agree to assume these risks. By signing below, I release Greater Levels, its employees, volunteers, independent contractors, directors, and agents based on any damage, loss or injury whether it is the result of ordinary negligence or otherwise, caused to my child or to me, from participation in the youth sports program.
I have read and understand the above and have completed this form to the best of my ability. I also support the Greater Levels youth sports philosophy, which is based on participation, fun, physical fitness, and health, skill development, team work, fair play, family involvement and volunteer leadership.
Signature of Parent or Guardian:
_____________________________________________________________________________________
Attachments:
