2026 Senior Registration Form

Name of player

First NameLast Name

Date of Birth

dd/mm/yyyy

ID/PASSPORT NUMBER

dd/mm/yyyy

Have you been cleared from any other Hockey, Basketball or Netball club?

Sporting code you would like to join?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

I take fully responsibility for all the club fees and will not be cleared from the club until I have fully paid my fees.

Release & Liability

In Consideration of my/our child being allowed to participate in any way for the Ditlou Titans Youth Sports team for the season, it's related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant and while particular rules, equipment and personal disipline may reduce the risk, the risk of serious injury does exist; and

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsilbity for my participation; and I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe an unusual and significant hazard during my presence or participation, I will bring such to the attention of the nearsest official immediately; and

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless DTSA, and it's officers, officials, agents and/or volunteers and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability or loss or demage to person or property, wheather arising from the negligence of the releases or otherwise, to the fullest extent by law.

If a child leaves a practice or game for any medical reason, he or she cannot return without medical clearance from a physician. At any time, a coach can require medical clearance of a player to be able to participate or play at his/her own discretion.

Popi Act release statement: I also hereby consent, without further consideration or compensation, to use (full/partial) of all photos, audios or videos made of my child or family members during DTSA sporting events, for the purposes of events documentation, promotional materials or web content. Further, I release DTSA and its volunteers from any liability, which may arise from the use of those photos

I have read this release of liability and assumption of risk agreement. I fully understand its terms. I understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

I First Name Last Name , state that I have read and understood the terms and conditions on the indemnity form.

Date on blank