Chevy Chase Track Club

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Registration 2017

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Home Phone:

* Birthdate:

Email:

* Age:

* 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 #:

* Date of Birth:

Location:

PAYMENT,REFUND AND CANCELLATION POLICY

Full payment must be made at time of registration.
Registrations will be cancelled if full payment is not received with 7 days of registration.
Refunds: A full refund will be made when a program is cancelled due to schedule or location change, or insufficient enrollment. A full refund will be made prior to 7 days before the beginning of the program.

I, Parent/Guardian of minor child, agree with the above *

LIABILITY AND ASSUMPTION OF RISK

Bethesda Sparks assume no liability for injuries or damages arising from participation in any class or program. Due to the strenuous nature of some activities, the participant, and if applicable, the participant’s parent/guardian, are urged to consult a physician concerning fitness to participate. All activities can present inherent risk and hazards, which the participant, and if applicable, his/her parent/guardian assume responsibility. The participant, or the participant’s parent/guardian consent to emergency treatment.
If the participant is a minor, the parent/guardian must approve of his/her child's participation in Bethesda Sparks.
Through registration, participants, or the participant’s parent guardian agree, to these policies.

I, Parent/Guardian of minor child agree *

PUBLICITY PARTICIPATION

Videotaping and/or photography may occur during Bethesda Sparks activities. I understand that such material may be used in publicity and/or educational efforts by Bethesda Sparks. In addition, with staff permission and supervision, news media may photograph, videotape, and/or interview some of the children attending GirlsUP. I consent to having the my child's voice and/or image recorded or photographed for use as outlined above.

I, Parent/Guardian of minor child agree

T-Shirt Size:

CODE OF CONDUCT

All Bethesda Sparks participants agree to respectfully listen and abide by the coaches' instructions and to refrain from disrespectful behavior and language towards other participants.

I agree and have discussed the Code with my child/children *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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Registration 2017