Clone of IMPACT Sports: Sign-up Form

IMPACT Sports Sign-up Form

Please enter accurate information for you and your child. If you have more than one child, you will need to fill out a form for each child. If you have already submitted a form for your child, you do not need to do so again unless your contact information has changed. If you have any questions, please contact Stacey Ashmore (864) 478-0739 or Miguel Giraldo (864) 467-4099.
Participant Information
Name of Participant*

First NameLast Name
Date of Birth*
Age*

6789101112
Please select a sport.
School & Grade*
Insurance & Policy Number
Parents/Guardian Information
Name of Parent/Guardian *

First NameLast Name
Phone Number 1*
Please enter a valid phone number.
Name of Parent/Guardian

First NameLast Name
Phone Number 2
Please enter a valid phone number.
E-mail
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Name of Contact*

First NameLast Name
Relation to child*
Phone Number*
Please enter a valid phone number.
Parent/Guardian Consent/Release:
My child is joining Youth Impact Sports program (IMPACT) with my consent. I therefore give my consent to IMPACT to transport my child to events under the sponsorship or guidance of IMPACT, so that my child may engage in such sports activities. I agree to return all equipment given to my child by IMPACT, and I also agree to return all equipment clean and in good repair. Furthermore, I agree to obey, as a parent or guardian, and to have my child obey IMPACT rules and regulations and I will assist to further the IMPACT program in any way possible. I understand that, if my child or I do not obey the IMPACT rules and regulations, my child, could be expelled from such program. We, the undersigned, hereby bind ourselves, our heirs assigns and personal representatives to waive and release IMPACT Sports program and any and all their agents, officers, coaches, committees, representatives, members and/or member’s parents, as well as any other football associations, teams, schools or officials, or team members, against or with whom the participant name below may participate or practice from any and all claims or right to damages for injuries or losses suffered directly or indirectly in training, workout, attendance, participation in or travel from practices or competition. Finally, I understand that concerning my child’s transportation, playing or games, practices and other sanctioned IMPACT activities, if any injury does occur, I release and will not hold responsible the IMPACT, its director, coaches, or employees for any injury or damage sustained. I HAVE READ AND AGREE TO THE ABOVE CONSENT/RELEASE.
Signature*

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IMPACT Sports Sign-up Form

Participant Information

Parents/Guardian Information

Emergency Contact Information