UAA Participant Registration Form

Participant Registration Form

Ummah Athletics Association (UAA)
Player Name

First NameLast Name
Player Birth Date

MonthDayYear
Player Gender
Desired Sports/Fitness Program
T-shirt Size
Parent Contact Name

First NameLast Name
Parent Contact Phone
Format: (000) 000-0000.
Parent Contact E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Conditions / Allergies:
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Player
Parental Consent - I give permission for my child to participate in the Ummah Athletics programs. I understand that volunteers are supervising and that reasonable precautions will be taken to ensure safety. In the event of an emergency, I authorize medical treatment if I cannot be reached.
Should be Empty: