Course Registration Form

Emergency Contact & Health Insurance Information
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Health Insurance*

Insurance NameGroup NumberPolicy Number
Do you have any medical conditions, allergies, or chronical illness that would limit high level activity? If so, explain.*
*if none put N/A

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to a medical facility to secure any and all necessary emergency medical care for my child.
Release of Liability

Although the safety of all sport activities is the primary concern, indoor/outdoor activities at T.I.M.E. Youth Sports, Inc. may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue claim against T.I.M.E. Youth Sports, Inc. and the persons in charge.
Release of Media/Photographs

I grant permission and give my consent to T.I.M.E. Youth Sports, Inc for the use of photograph(s), videos or electronic media images for presentation and promotions for T.I.M.E. Youth Sports, Inc. including any social media platform accounts including, but not limited to Twitter, Facebook, Instagram, etc..
I have read and agree to the above conditions *

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Registration Form