2001 Pierrefonds Cobras Girls

Subscribe to our Newsletter

Player Information Form

PLAYER INFORMATION

* First Name:

* Last Name:

Preferred Position:

* Birthdate:

Player Email Address:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Street:

* City:

Province:

* Postal Code:

* EMail:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

* Firstname:

* Lastname:

* Street:

* City:

Province:

* Postal Code:

* Email:

* Home Phone:

Work Phone:

* Cell Phone:

MEDICAL INFORMATION

* Emergency Contact:

* Phone:

Medical History

* Please Detail any medical conditions your child may have:

WAIVER INFORMATION

I (We), the undersigned, understand that it is my responsibility to keep the team management advised of any change in the above mentioned information. In the event my child sustains an injury during practice or a game, and myself nor none of the aforementioned individuals can be contacted, I authorize the team management to take my child to the hospital/MD if deemed necessary. I also authorize the physician and nursing staff to undertake examination and treatment of my child and accept the released of the aforementioned information to the appropriate people (coach, physician) as deemed necessary.

I/we agree with the above *

Signature:

Date:

Signature:

Date:

* indicates required fields

OUR SERVICES

LOCAL SPORTS

ELITE

Player Information Form