Clayton Trojans Drumline Registration Form

A CHILD'S D.R.U.M.S. INC.

CLAYTON TROJANS DRUMLINE SIGN-UP FORM

(ages 7 to 14)

P.O. BOX 46733

CINCINNATI, OH 45240

Contact: Cincinnati - 513-334-6594 or Atlanta - 404-939-3398

Email: Claytontrojanspercussion@gmail.com or Achildsdrums@gmail.com
Percussionist Information
Player's Name *

First Name Last Name
Age *
Guardian / Parent's Name *

First Name Last Name
Guardian / Parent's Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Home Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
E-mail *

Skill level *

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Important Notes

· Dress appropriately. Also, NO FLIP FLOPS, SLIDES or SANDLES! YOU WILL NOT PRACTICE!

· Keep all equipment clean and unbroken.

· The league organizers reserve the right to form the drumline to ensure the talents of the battle squad are correct.

· Fee: $50 per week for each participant. Includes Full uniform, All season football games plus playoffs, and performing at various events.

***Beginners may be asked to take a beginners class in order to make the battle squad.***
Emergency Contact & Health Insurance Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Do you have health insurance ? *

Yes No
Insurance Carrier
Name of Policy Holder
Subscriber ID
Group Number
Does the child have any allergies? *

Yes No
Please describe *
Does the child have any chronic illnesses or medical conditions? *

Yes No
Please describe *
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Release of Liability

Although the safety of all activities is the primary concern, activities with CLAYTON TROJANS DRUMLINE (A CHILD'S D.R.U.M.S. INC) may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Clayton Trojans or A CHILD's D.R.U.M.S. INC or any employees or affiliates.
I have read and agree to the above conditions *

Yes
Child's Signature *
Parent / Guardian's Signature *
Date *

Month Day Year

Type a question

Should be Empty:

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Release of Liability