Got Game Sports Pittsburgh

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Got Game Camper Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Home Phone:

* Birthdate:

Email:

* Gender:

* Grade (as of 2018/19 school year):

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy # (Optional):

WAIVER INFORMATION

In consideration for being permitted by the above program to participate in the above activity, I herby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which my child may have, or which may hereafter occur to my child, as a result of participation in said activity. This release is intended to discharge in advance the above program (its officers, employees, volunteers, and agents), Got Game Sports, from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I understand that this activity involves an element of risk and danger of accidents and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which that may incur as the result of death or any injury or property damage that my child may sustain while participating in said activity.

I hereby additionally consent that my son/daughter may participate in the above activity and I hereby execute the above AGREEMENT, WAIVER, AND RELEASE on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity.

I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the above program and I consent it of my free will. I further understand that no medical insurance is provided and that no refunds will be given unless activities are changed or cancelled by Got Game Sports.

I further understand that photographs and video may be taken during the course of the said activity and that these photographs and video may be used for Got Game Sports publicity/Marketing purposes I HAVE READ AND UNDERSTAND THIS RELEASE.

By checking this box, I/we agree with the above and consent to my child's participation. *

Note: Camp fee payment must be made in person upon arrival on the first day of camp. Other arrangements for payment prior to the first day of camp may be made by contacting Coach Mike at (412) 609-8411.

* Please select T-shirt size (we will try to match as best as possible):

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Got Game Camper Registration