PVS Panthers Sports Registration
Age as of 06/01/18
As of Fall 2018
Sports Interested in Playing:
Girls' Soccer (2nd-12th)
Boys' Soccer (2nd-12th)
Boys' Basketball (5th-12th)
Girls' Basketball (5th-12th)
Parent/Guardian First Name:
Parent/Guardian Last Name:
Parent/Guardian Home Phone #:
Parent/Guardian Cell Phone #:
Acknowledgement/Waiver/Agreement1. I/We, the parents/guardians of the above-named participant, hereby give my/our approval to participate in any and all activities. 2. I/We know that participation in sports/fitness activity/program may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless PVS Panthers, the organizers, sponsors, supervisors, coaches, participants, and team from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.3. To permit the use of participant's likeness (e.g. photos, videos, etc.) and/or name in advertisements, press release and literature, and/or posted on the website for the above program. 4. Give consent for an authorized PVS Panthers representative to take participant/my child/children for care, medical or dental, in an emergency situation where the condition represents a serious or imminent threat to his/her life, health or well-being. I understand that conscious effort will be made to notify me prior to such action, and that the expense, if any, will be borne by me.
Terms and Conditions Acceptance
I/We Hereby Accept the Terms and Conditions above.
Emergency Contact Name:
Emergency Contact Primary Phone Number:
Name of Medical Insurance Company:
Does the participant have any allergies, present medication, special considerations, etc.:
If Yes, Please Explain:
Submit Above Information
Should be Empty:
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