ATHLETE REGISTERATION FORM

ATHLETE REGISTRATION

Child Name

First

Last

Date Of Birth

School

Age Group1

Address

Address Line 1

City

State / Province / Region

Country

Parent / Guardian Name

Phone

Email

Emergency Contact #1

Emergency Contact #2

Allergies

Medical Notes

PARENT/GUARDIAN CODE OF ETHICS

Parents are expected to model respect and sportsmanship at all events

Parent / Guardian Name

Phone

Email

Checkboxes

Respect all participants

Checkboxes (copy)

Positive sideline behaviour

Checkboxes (copy) (copy)

Private conflict resolution

Checkboxes (copy) (copy) (copy)

Playing time based on effort and safety

Checkboxes (copy) (copy) (copy) (copy)

Follow rules

LIABILITY WAIVER AND MEDICAL CONSENT

I acknowledge inherent risks and consent to emergency medical treatement if necessary

I agree to the waiver and medical consent

MEDIA RELEASE (Photo/Video)

Permission to use photo/video for program promotion

Yes
No

CONCUSSION AND INJURY ACKNOWLEDGMENT

I unterstand concussion signs and agree to report immediately

I acknowledge and agree

ACADEMIC AND BEHAVIOUR RESPONSIBILITY

Students-athletes are expected to maintain effort and respect at school

Checkboxes

Attend school regulary

Checkboxes (copy)

Respect teammates and staff

Checkboxes (copy) (copy)

Follow team rules

Signature

Clear Signature