Waiver - Bubble Bump Soccer
Complete the participant, signer, and emergency details, then review and sign electronically.
Event or organization name
*
Event date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant first name
*
Participant last name
*
Participant date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Based on the date of birth above, is the Participant an adult or a minor child?
*
Adult (18 or older) — I am registering and signing for myself
Minor child (under 18) — a parent or legal guardian will sign on their behalf
Your mobile phone (if Participant is an adult)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your email (if Participant is an adult)
*
example@example.com
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 (optional — leave unchecked to use the parent/guardian above as the emergency contact)
Someone other than the parent/guardian above is the emergency contact
Emergency contact name
*
Emergency contact phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies, medications, or medical conditions
*
Please Read Before You Sign
Read the full 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 Waiver - Terms & Conditions (Release of Liability and Assumption of Risk), and I am the Participant (if 18 or older) or the Participant's parent or legal guardian (if the Participant is under 18)
*
I agree
I authorize emergency medical treatment for the Participant and accept responsibility for its costs
*
I authorize
Signature (Participant, if 18 or older; or Parent/Guardian, if the Participant is a minor)
*
Submit Waiver
Submit Waiver
Should be Empty: