PARTICIPANT INFORMATION
Training Grounds Inc.
Lifting Our Values Everyday (L.O.V.E)
Youth Development Program Registration
Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Gender
*
Male
Female
Address
*
Address
Street Address Line 2
City, State & Zip Code
State / Province
Postal / Zip Code
Tee Shirt Size
*
Child- XS
Child- S
Child- M
Child- L
Adult- S
Adult- M
Adult- L
Adult- XL
Adult 2XL
PARENT/GUARDIAN INFORMATION
Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Name
First Name
Last Name
Phone Number
Email
example@example.com
EMERGENCY CONTACT INFORMATION
Contact #1 Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Contact #2 Name
*
Relationship
*
Phone Number
*
Please enter a valid phone number.
MEDICAL INFORMATION
Describe any medical conditions, allergies, or special needs the staff should know about your child?
*
In the event that my child experiences a medical emergency, I give permission for Training Grounds, Inc. staff to administer first aid and/or other life sustaining techniques and contact emergency personnel in the event that my child is injured or ill. I understand that I will be financially responsible for any medical attention needed during participation or resulting from any injury or illness that happens while my child is in the care of program staff. I will not hold Training Grounds for any injury or accident that happens while my child is at the center.
*
INITIAL HERE
MEDIA RELEASE
I the undersigned, do hereby outline my permission to use the image of my child's marked by my selection below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of me for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Web site.
*
I grant permission to use my child’s images
I do not give permission for my child’s images to be used
PERMISSION TO RELEASE INFORMATION
In order to provide the best services possible, I understand that Training Grounds may need to share personal information with your child, to one of our trusted partners. The information may be educational, social and/or psychometric in nature. Information can also be shared to help implement and evaluate the Youth Development Program. I give Training Grounds permission to share information pertaining to my child, with trusted partners.
*
INITIAL
PERMISSION TO TRANSPORT
I hereby give permission for my child to be transported to and from pre scheduled field trips and activities. I understand that staff will supervise all activities and will provide parents with advance notification about the date,time and location of planned activities as well as coordinate transportation arrangements.
*
INITIAL HERE
PERMISSION TO RELEASE CHILD UNDER OWN CARE
For participants who will be traveling independently via public transportation, ride share and/or driving their personal vehicle.
I hereby give my child permission to be released under his/her own care at the end of a program day. I understand that I will be responsible for coordinating my child’s mode of transportation and communicating those arrangements to Training Grounds staff. I release all responsibility from Training Grounds once my child exits Training Grounds' care
*
INITIAL HERE
RELEASE FROM LIABILITY
Training Grounds staff will also work to ensure a safe environment for its participants. I acknowledge that some activities may produce an inherent risk of injury therefore I agree to accept responsibility for the risks that may occur. I hereby agree to waive, release and discharge any and all claims for damages, for death, personal injury or property damage which my child may have or which may hereafter accrue as a result of my child's participation in this program against their person or entity whether such injury or damage was foreseeable. This acknowledgement of and assumption of risk and release shall be binding upon heirs and assigns.
*
INITIAL HERE
Parent/Guardian Name
*
Parent/Guardian Signature
*
Date
*
/
Month
/
Day
Year
Date
Preview PDF
Submit
PERMISSION TO TRANSPORT
Should be Empty: