Evanston Bulldogs Youth Association Detailed Registration Form

Evanston Bulldogs Youth Association Registration

https://dawg4life.com
Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Program your child will participate in? *
Grade
Gender

Male Female
Child's Age *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name *

First Name Last Name
Home Number
Cell Number *
E-mail *
example@example.com
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Alt. Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the athlete prescribed an inhaler? If yes, please explain any instructions. *
In regard to the above-mentioned person, please check all that apply and provide an explanation below if needed: *

EPLISEY BEE ALLERGY IMPAIRED HEARING ATTENTION DEFICIT DISORDER ASTHMA/ALLERGIES HIGH BLOOD PRESSURE DIABETES ARTHRITIS COVID-19 EXPOSURE AUTISM SPECTRUM SKIN TROUBLE N/A Other
OTHER: Explanation if needed:
I hereby grant the permission necessary to allow the minor listed above to participate in the above noted SPORTS or other events, including basketball, baseball, flag football, soccer, full tackle football or cheer, or Girl Scouts or any other youth programs to be sponsored by the Evanston Bulldogs Youth Association (EBDS). I acknowledge and agree on my own behalf of the minor, that such participation subjects the minor to the possibility of physical illness or injury (minimal, serious, catastrophic and or death including 2019 novel coronavirus) and I am, on my behalf of the minor, acknowledge that the minor is assuming the risk of such illness or injury by participating in the above noted EBDS event.

Appearance/Photography: I understand that the EBDS at times produces promotional materials related to the youth program. I understand that as a participant in and or the spectator of at above noted that the EBDS event the minor may be included in video tape, photographs or recordings taken during above noted EBDS events. I give permission for the images to be used on all EBDS social media sites including print and digital media.
Medical Release and Authorization

In the event of such illness or injury, I authorize the EBDS organization to obtain necessary medical treatments for the minor and hereby, on my own behalf and on the behalf of the minor release and hold harmless the Evanston Bulldogs Youth Association , the hosting site (on whose premises the event will occur- and here in after the hosting site) it affiliates, the affiliates of EBDS and the respective directors, officers, representatives of EBDS. Here in after collectively release any exercises of this authority. I further acknowledge and understand that I will be responsible for all and any medical and related bills that many be incurred on behalf of the minor and for any illness or injury that the minor may sustain during the noted EBDS event and while travelling to and from the event site for the above noted EBDS whether or not the EBDS sponsored event actually occurs.
Confirmation

I on my own behalf and on behalf of the minor, hereby warrant that I have read this RELEASE and WAIVER in its entirety and fully understand its contents. I on my behalf and behalf of the minor further acknowledgement that nothing in the RELEASE and WAIVER constitute guarantee that the noted EVANSTON BULLDOGS YOUTH ASSOCIATION dba EVANSTON BULLDOGS FOOTBALL AND CHEER sponsored event will occur, I on my own behalf and behalf of the minor, have signed this document and voluntarily and of my own free will without threats promises of goods or monetary rewards.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

Month Day Year
Date
Should be Empty:

Evanston Bulldogs Youth Association Registration