Rally Sport Registration-ZeroZero

Rally Sport Registration Form

Rally Sport Soccer - Saturday, March 26 - 8:30 AM - 11:30 AM- Restoration Academy- 4600 Carnegie Avenue, Fairfield, AL 35064 August - Basketball, September and October - Baseball, November and December - Volleyball, January - Golf, February - Football, March - Soccer, April - Football, May - Basketball, June - Golf, July - Soccer
Participant's Information
Participant Name *

First Name Last Name
Nickname
Gender *
Date of Birth *

Month Day Year
Reminder: Rally Sport is for kids aged 6-12.
School Participant Attends: *
Grade Just Completed (2021/22 School Year) *
Which Rally Sport Events Are You Interested In? *

Basketball Football Volleyball Golf Soccer Baseball/Softball
T-Shirt Size *
Size is not guaranteed, but we will do our best to fulfill your request
Please provide any additional information that you think is important or may affect the participant's ability to fully participate in the program.

Parent's/Guardian's Information

Only the parent/guardian or emergency contact will be able to pick up the participant. You will be required to show valid photo identification in order to pick up the participant.
Parent/Guardian #1
Parent/Guardian #1 *

First Name Last Name
Relationship to Child *
E-mail *
Cell Phone *
Home Phone
Work Phone
Where would you like to be reached while your child is at Rally Sport? *

Cell Phone Home Phone Work Phone
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian #2
Parent/Guardian #2

First Name Last Name
Relationship to Child
E-mail
Cell Phone
Home Phone
Work Phone
Where would parent/guardian 2 like to be reached while your child is at Rally Sport?

Cell Phone Home Phone Work Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contacts/Authorized Pickup

Parent/guardian cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be able to take responsibility for the child in case the parent/guardian cannot be reached. Only the parent/guardian or emergency contact will be able to pick up the participant. You will be required to show valid photo identification in order to pick up the participant.
Emergency Contact #1
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Cell Phone Number *
Home Phone Number
Relationship to Child *
Emergency Contact #2
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Cell Phone Number *
Home Phone Number
Relationship to Child *

Statement of Understanding
I, the undersigned, hereby authorize Zero Zero Foundation to photograph, take motion pictures, take video footage, and/or make electronic sound recordings of the registered camper (herein referred to as photographic or electronic reproductions). *

Yes No
I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by Zero Zero Foundation. (I understand that the camper may be identifiable from such photographic or electronic reproduction) *

Yes No
Sign Document *
Date Signed *

Month Day Year
Today's Date
Should be Empty: