CHSS Enrollment & Waiver Form

Parent/Guardian Information

Name*

First NameLast Name

E-mail*

example@example.com

Contact Number*

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Athlete Information

Athlete's Name*

First NameLast Name

Grade

Birth Date*

MonthDayYear

Gender*

MaleFemale

Are you with a Charter School?*

NoSuncoast Prep AcademyOther Charter School (Please Specify)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please Use Code at Checkout

Here's your coupon code:

SunnyDays

Here's your coupon code: Please Use Code at Checkout

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.*

Type No or N/A If Question Does Not Apply

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

Type No or N/A If Question Does Not Apply

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Crowned Homeschool Sports during the selected camp. In exchange for the acceptance of said child’s candidacy by Crowned Homeschool Sports., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Crowned Homeschool Sports. 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 Crowned Homeschool Sports. 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.

If a child leaves a practice or game for any medical reason, he or she cannot return without medical clearance from a physician. At any time, a coach can require medical clearance of a player to be able to participate or play at his/her own discretion.

Photo release statement: I also hereby consent, without further consideration or compensation, to use (full/partial) of all photos, audios or videos made of my child or family members during sporting events, for the purposes of events documentation, promotional materials or web content. Further, I release Crowned Homeschool Sports and its volunteers from any liability, which may arise from the use of those photos.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, 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 Crowned Homeschool Sports. 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.

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.

Signature*

Date*

Date

Thank you! We are currently forming our group classes. We will contact you with next steps once groups and schedule are finalized.

Pick Your Class*

Physical Education Class

Speed, Agility, Strength & Conditioning

$35

Group Sports Training

Focus on skill development

$35

Crowned Homeschool Sports Enrollment & Waiver Form