Whitefield Athletic Association

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Soccer 2019

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Shirt Size:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

WAIVER INFORMATION

I, the undersigned parent/legal guardian, agree and understand that participation in this sport is hazardous and may result in injury. In consideration for the ability of my child(ren) to participate in sporting events sponsored and/or coordinated by the Whitefield Athletic Association (WAA), I, the undersigned parent/legal guardian of the above named child(ren), agree to assume all risks of injury incurred or suffered while participating in the WAA program and hereby waive and release all right and claims for damages I may have against the WAA, its officers, staff, agents, and coaches for any and all injuries suffered by my child while participation in this program (i.e.Soccer, Basketball, Baseball/Softball, Tee-ball practices or games) of the WAA. By signing/checking box below I certify and agree that (1) I am the parent and or legal guardian of the child(ren) listed above: (2) I am responsible for and do have current accident/medical insurance covering the child(ren) listed above; (3) I give my approval for my child(ren) listed above to participate in the WAA sporting activity listed above:(4) My child(ren) is/are physically capable of participating in this WAA activity, and (5) in he event that my child(ren) requires emergency medical treatment,I hereby give permission for such treatment to be given in the event that I cannot be directly contacted.
I have read the foregoing RELEASE AND INFORMED CONSENT, understand them and agree to abide by them.

I/we agree with the above *

* indicates required fields

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Soccer 2019