ESYN Sports Registration & Liability Waiver
Register your child or adult for sports and complete the required consent and waiver.
Participant Information
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Information
Emergency Contact Full Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Participant
*
Medical Information
Medical Conditions, Allergies, or Medications
Medical Insurance Carrier and Policy Number
Consent to Treat
I authorize the organization to secure emergency medical treatment for my child if necessary.
*
Yes, I consent
No, I do not consent
Liability Release & Waiver
I, the parent/guardian, acknowledge and accept the risks of sports participation and hereby release the organization and its staff from any liability for injuries or damages that may occur. I have read and understand the terms of this waiver.
*
I agree to the terms above
Do you consent to your child being in photographs or videos on our website and social media
Yes
No
Parent/Guardian Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Registration
Submit Registration
Should be Empty: