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2025 HDBB 13-14 Fall Registration Form

PLAYER INFORMATION

PARENT/GUARDIAN #1

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION
I agree that all information listed is correct and true. I understand if the information is not correct, my child can be ineligible for post season play and ineligible for league insurance coverage in the event of injury.

Injuries and illness (examples include: communicable diseases such as MRSA, influenza, and COVID-19) to participants in youth sports programs may occur from risks inherent in that sport or activity; from placing stress on the body that has not been prepared for; from accidents in learning or practicing play techniques; from failing to follow game, training, safety, or other team rules; from the use of transportation to and from games and other events; and from administration of first aid. Injury can include direct physical, and possibly crippling, injury to one's body, and emotional injury experienced as a result of inflicting injury to another or witnessing it. The severity of injury can range from minor cuts, scrapes, or muscle strain to catastrophic injury such as paralysis or even death.

In consideration of the Hattiesburg Optimist Club, The City of Hattiesburg and its Department of Parks and Recreation permitting my child or ward to participate in its Youth Sports Program(s), I hereby agree on behalf of my child or ward that he or she will assume the risk of injury or death from participating as outlined above. I release the Hattiesburg Optimist Club, City of Hattiesburg, its Department of Parks and Recreation, the Departments employees, advisory councils, officials, and/or volunteers from any liability resulting from my child's or wards participating in this sport or activity. This assumption of risk and release binds my child's or wards, heirs, estate, executor, or administrator, and assigns all members of my family.

 

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