Diamond State Titans

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Player Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

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

Release & Waiver of Liability
I/WE RELEASE, WAIVE DISCHARGE, HOLD HARMLESS, INDEMNIFY AND COVENANT NOT TO SUE:
The Diamond State Titans,its Directors,staff or volunteers, coaches,trainers,officials,agency sponsors or advertisers, their respective administrators,officers directors, representatives,employees,and any other organizations, schools,agencies or individuals with whom the Diamond State Titans are associated with. This includes but is not limited to the AAU and any of their members,any private organization,local municipality,and/or state governmental agency which may be connected to or affiliated with activities or events,attended by or hosted by the Diamond State Titans. I/We will allow my son’s photograph,picture or likeness,scholastic & statistical information and/or voice to appear or be heard in any official documentary, Titans website,promotional (including any and all advertisements),television radio or film coverage, and the distribution of my son’s completed player profile to college coaches without compensation or cost to our family.
Signature of Parent/Legal Guardian for the indicated player constitutes understanding and agreement of this Player Profile Agreement as set forth above.

I/we agree with the above *

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