IACC & New Haven Gaelic Football & Hurling Club

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New Haven Gaelic Football and Hurling Club Registration

REGISTRANT INFORMATION

* Last Name:

* First Name:

Birthdate:

Street:

City:

State:

Zip Code:

Cell Phone:

Home Phone:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

First Name:

Last Name:

EMail:

Cell Phone:

Home Phone:

Work Phone:

PARENT/GUARDIAN #2

First Name:

Last Name:

Email:

Cell Phone:

Home Phone:

Work Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I the parent/guardian of the above named player(s) agree that I and the player(s) will abide by the rules of the IACC and the New haven Gaelic Football and Hurling Club. Recognizing the possibility of physical injury associated with Gaelic football and sport, I herby release, discharge and/or otherwise indemnify IACC and its affiliated organizations and sponsors and their personnel against any claims by or on behalf of the player as a result of the players participation in their games or programs, and/or any transportation which I hereby authorize. I hereby give permission for the above child(ren) to participate in the Gaelic sports during the 2019 athletic season, Further I authorize the NHGFC/IACC to provide emergency treatment to any injury or illness my child(ren) may experience if qualified medical personnel may consider treatment necessary and perform the treatment. This authorization is granted only if I can’t be reached and a reasonable effort has been made to do so.

I/we agree with the above *

* Electronic Signature:

* Date:

I give permission for my child to be photographed or videotaped for the purpose of visually depicting a program or activity for a presentation or publication while participating at NHGF&HC *

* indicates required fields

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New Haven Gaelic Football and Hurling Club Registration