Youth Participation Waiver - Bubble Bump Soccer
Complete the participant, parent/guardian, and emergency details, then review and sign electronically.
Event or organization name
*
Event date
*
-
Month
-
Day
Year
Date
Participant first name
*
Participant last name
*
Participant date of birth
*
-
Month
-
Day
Year
Date
Participant sex
Please Select
Male
Female
Prefer not to say
Age group or team
Parent or legal guardian name
*
Parent mobile phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent email
*
example@example.com
Relationship to participant
*
Please Select
Parent
Legal guardian
Emergency contact name
*
Emergency contact phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Policy number
Allergies, medications, or medical conditions
*
Please Read Before You Sign
Read the full Youth Participation Agreement, Release of Liability, and Assumption of Risk at bubblebumpsoccer.com/pages/waiver-terms before checking "I agree" below.
I have read and agree to the Bubble Bump Soccer Youth Participation Agreement Release of Liability and Assumption of Risk and I am the parent or legal guardian
*
I agree
I authorize emergency medical treatment for my child and accept responsibility for its costs
*
I authorize
Parent or guardian electronic signature
*
Submit Waiver
Submit Waiver
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