Razin Havoc

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Player and Cheer Registration form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Email:

* Gender:

* Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I understand that participation in the above event or activity could include actions or
tasks which might be hazardous to the participant named above.
By signing below, I assume any risk of harm or injury which might occur to the
participant due to his/her/my participation in the event or activity. I release the
organization or business named above from all liability, costs and damages which
might arise from participation in the above named event or activity.
If the participant is a minor, I agree that the minor has my consent to participate in the
event. I further provide my consent for the organization or business named above to
seek emergency treatment for the minor if necessary. I agree to accept financial
responsibility for the costs related to this emergency treatment.

I/we agree with the above *

* indicates required fields

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Player and Cheer Registration form