Backyard Athletic Association

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Backyard Athletic Association Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* Phone Number:

* Birthdate:

* Email:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

* Firstname:

* Lastname:

* Email:

* Home Phone:

* Work Phone:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

All participants in the Backyard Athletic Association (BAA) agree that by participating in any and all BAA activities they run the risk of injuries, by participating in activities you accept responsibility for any and all injuries minor or severe. Neither the BAA nor Mitchel Kirtley are to be held responsible for injuries. Your participation implies consent.

I/we Agree with the above

I/we Disagree with the above

* indicates required fields

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Backyard Athletic Association Registration Form