Registration Form

Registration Form

2025 Fall League - Form to be completed by Parent/Guardian only. Registration is not complete until Registration Fees are paid. Team email: info@truthathleticclub.com Team Website: www.truthathleticclub.com
Athlete Information
Player Name*

First NameLast Name
Player DOB*

MonthDayYear
Date
Player Cell #
Please enter a valid phone number.
Grade
Example: 5th grade, 6th grade, 7th grade, 8th grade, 9th grade, etc.
School of Attendance
Example: Jonesboro MS
Uniform Size
Are you 18 or older*

YesNo
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Cell Phone*
E-mail*
example@example.com
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Do you have health insurance ?*

YesNo, I'll pay with cash.
Insurance Carrier
Name of Policy Holder
Subscriber ID/Group Number
Card Number / Card Date
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe if answered "Yes".
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities with Truth Athletic Club and it's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Truth Athletic Club and the persons in charge.
I have read and agree to the above conditions*

YesNo

My Products*

2025 Fall Season1 player - Girls and Boys Middle and High School

$75.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Afterpay

Date Form Completed

MonthDayYear
Date
Name of Person completing Registration

First NameLast Name
Should be Empty:

Registration Form

Release of Liability

Payment Methods