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Player Waiver

Participant First Name *
Participant Last Name *
Participant Preferred Name
Participant Date of Birth *
School Grade This Year *
0.00
Participant Gender *
Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Email *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Relationship to Participant *
Does the participant have any allergies? *
If Yes, Please Specify
Does the participant carry an epi-pen? *
If yes, where is it kept so we are aware
Medical Notes (allergies, medical conditions, medications, or anything our coaches should know)
Guardian Consent for Emergency Medical Treatment *
Consent for Participation in All Activities *
Media Release Consent for Photos/Videos
Typed Signature (type your full legal name to sign) *