ESYN Sports Registration & Liability Waiver
Register your child or adult for sports and complete the required consent and waiver.
What activity are you signing up for?
Please Select
Bowling
Indoor Soccer
Spirit Horse Connections
IDance
Basketball
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: