Get Out And Play 2025 Registration& Waiver

This form must be completed separately for each athlete.

Athlete's Name

First NameLast Name

Grade

Birthdate

E-mail

example@example.com

T-shirt size

Emergency & Insurance Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Upload Photo of Insurance Card

Policy Number

Health Insurance Provider

Primary Physician

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list any medical conditions, including any requiring maintenance medication (i.e. Epi-pen, Diabetic, Asthma, Seizures):

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

Medical Condition

Required Treatment

YesNo

Medical Condition

Required Treatment

YesNo

Add Additional Medical Conditions Here

YesNo

If Yes, please explain.

YesNo

If Yes, please explain.

YesNo

If Yes, please explain.

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.)

Permission to Secure Treatment:

All camp staff are certified in First Aid, CPR, AED, EpiPen and asthma inhaler assistance. They will take whatever emergency medical measures are deemed necessary for the protection and safety of the camper within their training. In the event of any emergency, I authorize them to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for me or my minor child/ward's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I understand that this authorization includes transporting my child by ambulance if necessary to the nearest medical treatment facility if I am unable to be reached first.

Persons Authorized for Child Pick-Up:(in addition to emergency contacts previously listed)*

Rows	Name	Phone Number	Relationship to athlete
Name
Name
Name

Photo Release

I understand the photos of participants may be used for promotional purposes including flyers, brochures, newspapers and on our website. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Local Sports One Camp and its affiliates.

I Do give permission for my child to be photographed during Local Sports One events.I DO NOT give permission for my child to be photographed during Local Sports One events.

Confirmation

I, being the parent or legal guardian of the above-named player, completely understand the risks involved in and do hereby consent for my child to participate in any of the activities, games, practices, camps, clinics, tournaments of (Local Sports One LLC) entered into as an individual or with his/her team and to use the facilities of the provided ball parks or any other in-state or out-of-state facility designated as the location for team organized activities, practices or games. I consent to allow my child to participate in any Local Sports One LLC sanctioned event, clinic, tournament, league, or camp as a member of the participating Team, and hereby release, indemnify and hold harmless the sports facilities, players, directors, commissioners, agents, umpires, referees, employees and assignees from any and all liability, claims, actions, demands, and judgments arising out of any injury or loss sustained by the below named child, myself, my family or guests in connection with the Local Sports One LLC, any team or group practice sessions, any team sponsored or team recognized activities, travel or any other functions that the above-named player, myself, my family or guests invited to as members of the participating team.

Parent/Guardian Print Name

First NameLast Name

Date

Signature

2025 Get Out and Play USA Waiver

Athlete Information