The Arlen Specter US Squash Center Participant Form
Thank you for taking part in activities at the Specter Center - the world's largest community squash center and home of US Squash!
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Participant's Gender
*
Male
Female
Non-Binary
Prefer not to say
Participant's Preferred Language
*
Participant's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the Participant Vaccinated?
*
Please Select
Yes
No
Participant's School
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact: Full Name + Phone Number
*
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Signature
*
Submit
Should be Empty: