Kernersville Mavericks

Subscribe to our Newsletter

Registration Application

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

Assumption of Risk: I acknowledge and understand that there is a risk of injury involved in athletic participation. I understand that my child will be under the supervision and direction of a volunteer youth coach. I agree to follow the rules for the sport and the instructions of the coach in order to reduce the risk of injury to my child and other athletes. However, I acknowledge and understand that neither the volunteer youth coaches nor the Kernersville Mavericks organization, or tournament hosts USSSA, USBA, AAU organizations and other affiliates can eliminate the risk of injury in sports. Injuries may and do occur. Sports can be severe and in some cases may result in permanent disability or even death. I freely, knowingly, and willfully accept and assume the risk of injury that might occur from my child’s participation in youth athletics.

Release: In consideration of the Kernersville Mavericks organization, hosts USBA, USSSA, AAU organization and its affiliates allowing my child to participate in youth athletics, I hereby agree to release, waive, discharge, covenant not to sue, hold harmless, and indemnify, on behalf of myself and any other parent or guardian of my child, the Kernersville Mavericks organization, USBA, AAU, USSSA, its affiliate companies, and their respective volunteer youth coaches, officials, agents, employees, directors, members, officers and other staff members from liability to us and our child, as well as our personal representatives, assigns, heirs and next of kin, for any and all claims, suits or causes of action arising from or out of any injury, known or unknown, to property or body, that my child may suffer from participation in athletic sports associated with USBA, USSSA, AAU organizations and Kernersville Mavericks organization athletics, activities, or the above-described sports activities as well as its affiliates.

I/we agree with the above *

* indicates required fields

OUR SERVICES

LOCAL SPORTS

ELITE

Registration Application