Metamorphosis Youth Ambassadors

Student Name*

Birth Date*

MonthDayYear

Grade*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent Guardian Name*

Contact Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the student aware of their medical condition?*

Is the student prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in service learning activities and education prepared by {The Metamorphosis Community Project. Inc.} throughout 2025. In exchange for the acceptance of said child’s candidacy by {Metamorphosis} ., I assume all risk and hazards incidental to the service activities, and release, absolve and hold harmless {Metamorphosis} . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against {Metamorphosis} . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the {Metamorphosis} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Conduct Agreement

As Parent and/or Guardian of the named student, we agree to the following code of conduct:

We will behave and speak respectfully to all Metamorphosis Staff and volunteers

We will arrive and depart within the times specified by Metamorphosis UNLESS otherwise agreed upon with a Metamorphosis staff member

We will inform Metamorphosis Staff of any issues we have with participants, volunteers or staff in a proactive timely manner

We will not verbally berate, address with foul/obsene/disrespectful lanaguage, gestures or attitude

We will attempt to operate with Metamorphosis staff, volunteers and participants as a Team/Community

We will offer suggestions as to how to do the BEST for our community

We will do our best to have a good time serving others!

Confirmation

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

Signature

Youth Ambassador Registration

Student Information