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i45 Youth Sports SUMMER LEAGUE 2019

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Birthdate:

* Gender:

* Grade:

PARENT/GUARDIAN

* First Name:

* Last Name:

* email:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

WAIVER INFORMATION

1.I hereby certify that my child is in reasonable health and is capable of safe participation in the program indicated above. I assume all risks and hazards incidental to the conduct of this program.

2.I hereby authorize the i45 YSA to obtain medical treatment for my child in the event that the parent and emergency contact cannot be reached.

3. I hereby release the i45 YSA, its employees, its board, and contractors from any and all causes of action and or claims for any physical injuries, personal losses, or damage done to personal property while on the premises of either the i45 YSA, or properties associated with specific programs of the organization.

3. I agree to indemnify and save the i45 YSA from any claims or demands arising
out of any such injuries or losses.

4. I authorize the publication of any photography taken for or during this program for the use of promoting or advertising further programs, unless I notify the i45 YSA, of my desire to not permit any published photos at the time of registration.

I agree with the above *

Signature:

Date:

* indicates required fields

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i45 Youth Sports SUMMER LEAGUE 2019