Sports Registration Form

Sports Registration Form
I would like to register for:
Athlete Information
Player Name*

First NameLast Name
How old are you?
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
E-mail*
example@example.com
Skill level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Important Notes
- Dress appropriately.
- No food in the gym.
- Keep the gym clean.
- Bring a water bottle
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Do you have health insurance ?

YesNo
Insurance Carrier
Name of Policy Holder
Subscriver ID/Group Number
Do you have any allergies, chronic illness, or medical conditions that would limit high level activity?*

YesNo
Please describe*
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:
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities 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 any claim against Growth and Performance Athletic Academy and the persons in charge.

Photo/Media Policy

I acknowledge and agree that Growth and Performance Athletic Academy may take photographs and video of individuals or groups participating in programs and
events and may use any photographs(s) and/or video taken of me or my child to publicize the program.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
example@example.com
Signature*

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Sports Registration Form

Photo/Media Policy

I acknowledge and agree that Growth and Performance Athletic Academy may take photographs and video of individuals or groups participating in programs and events and may use any photographs(s) and/or video taken of me or my child to publicize the program.

I acknowledge and agree that Growth and Performance Athletic Academy may take photographs and video of individuals or groups participating in programs and
events and may use any photographs(s) and/or video taken of me or my child to publicize the program.