Scrimmage Club Registration

Scrimmage Club Registration

Waiver, medical release, photo release, and pickup. One form per family.
Please complete and sign before your child's first session. It takes about five minutes. Questions? Email hello@scrimmageclub.com or text Coach Nick at 360.281.8938.
1. Your family
Parent or guardian

First NameLast Name
Phone

Area CodePhone Number
Email
We'll send your signed copy here.
Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Kids registering. Add each child. Leave extra rows blank.
Child 1: full name
Child 1: date of birth

MonthDayYear
Child 2: full name
Child 2: date of birth

MonthDayYear
Child 3: full name
Child 3: date of birth

MonthDayYear
2. Emergency contact and health
Emergency contact
Someone other than you
Emergency contact phone

Area CodePhone Number
Child's doctor
Name and clinic
Insurance carrier
Policy number
Anything the coach should know
Allergies, asthma, seizures, diabetes, past injuries, or medications. Name the child. Write "none" if none.
Does any child carry an inhaler, EpiPen, or other emergency medication?
If yes, which child, what medication, and where is it kept?
3. Medical treatment
If one of your children is hurt and we can't reach you, you give Scrimmage Club and Coach Nick Aufenkamp permission to get emergency medical care for that child, including calling an ambulance. We will always try to reach you first. You are responsible for the cost of that care. Scrimmage Club does not carry medical insurance for participants.
Parent or guardian initials

Draw or type your initials
4. Risks and release
Sports involve physical activity and carry a real risk of injury: sprains, breaks, concussions, collisions with other kids, the ball, or equipment, and in rare cases serious injury. Good coaching and supervision reduce these risks but cannot remove them. You confirm each child listed above is healthy enough to participate, except for anything you noted, and you'll tell the coach if that changes.

In exchange for your children taking part, you and each child listed above release Scrimmage Club, Nick Aufenkamp, and their volunteers from any claim for injury, illness, or property damage that comes from participating, including claims based on ordinary negligence, as far as Washington law allows. This does not cover gross negligence or intentional harm. You also agree to cover any claim brought against Scrimmage Club because of your own child's conduct.

Classes are held at facilities Scrimmage Club rents, including Clark County Indoor Sports Center, which may ask you to sign its own waiver. Please follow facility rules, including no cleats on the turf.
Parent or guardian initials

Draw or type your initials
5. Pickup
Scrimmage Club supervises children during their class time only. You're responsible for your kids before and after class, and for any siblings on site. Please pick up promptly at the end of class. Besides you, these people may pick up your children:
Authorized pickup 1: name
Authorized pickup 1: phone

Area CodePhone Number
Authorized pickup 2: name
Authorized pickup 2: phone

Area CodePhone Number
6. Photos and video
We sometimes take photos and short videos during class for the website and social media. Kids are never identified by full name. Your answer doesn't affect participation, and you can change it anytime by emailing us.
Photo and video permission
7. Club policies
The season is $99 per child for six weeks. Each class needs at least 9 kids registered by October 11 to run. If yours doesn't, we'll offer the other class first, or a full refund. There are no refunds for missed classes; make-ups are handled case by case. If we have to cancel a class for a facility closure or coach illness, we'll schedule a make-up or refund that week.

We ask every kid to try hard, treat teammates and opponents with respect, and listen to the coach. A child who repeatedly puts others at risk may be asked to sit out the rest of that class, and we'll always tell you why.
8. Signature
I have read this form, I understand it, and I'm signing it voluntarily. I'm the parent or legal guardian of every child listed above.
Parent or guardian signature

Draw with your finger or mouse
Date

MonthDayYear
Should be Empty:

Scrimmage Club Registration

1. Your family

2. Emergency contact and health

3. Medical treatment

4. Risks and release

5. Pickup

6. Photos and video

7. Club policies

8. Signature