*Choose Sport:
*First Name:
*Middle Name:
*Last Name:
*Parent Name
*Address: Street., City, State, Zip
*Present Age:
*Date of Birth: MM/DD/YYYY
*Phone Number: ex. 728-2222
*Emergency Contact Number: ex. 728-2222
*Team Played On Last Year:
*School Child Attends:
*Grade:
Medical Information
*My child has had a physical in the past year: YES NO
Physical Date: MM/DD/YYYY
My child is allergic to the following: 1.
  2.
  3.
My child is covered by hospitilization insurance: YES NO
Policy Name:
*Family Doctor:
Does your child take medication daily (inhalers, etc.) If yes please list:

*MUST READ BEFORE SUBMISSION*

By submitting this form, I am agreeing to give my son/daughter permission to participate in the sport of my choice. By doing so, I assume all risks and hazards incidental to such participation. I agree to hold blameless the Coaches, and the School System in case of an accident or injury. I understand that I am responsible for any equipment or uniforms issued and I will return such after the season has been completed. The cost of replacement of any damaged or unreturned equipment will be the responsibility of the parent or guardian.

Also, as a parent, I will not use obscene language or direct derogatory remarks towards officials, managers, or players, during or after games or practices. I understand I may be removed from the field with whatever means necessary. I also may be restricted from all the games for the rest of the year. A spirit of good SPORTSMANSHIP should prevail during and after all games.