TeamPages - Deerfield Young Warriors Registration and Release Form

Deerfield Young Warriors Registration and Release Form

This form is not collecting results at the moment. Deerfield Young Warriors Registration and Release Form does not collect results after 2017-07-17.

hideYou should not enter any sensitive information on this page such as health data, passwords or social security numbers. If you are being asked or need to provide this information for your registration please contact Deerfield Young Warriors directly.

Deerfield Young Warriors Registration and Release Form

As parents/guardian of the child named below:
• I certify that it is with my full knowledge and consent that he participate on the Deerfield Young Warriors Basketball Team and is eligible to do so.
• I agree NOT to hold the Deerfield Young Warriors, its director, or its coaches responsible for any injury my child/ward may sustain while engaged in either practices, games, or while traveling to and from practices or games.
• I agree NOT to hold any game or practice facility liable for any injury my child/ward may sustain.
• I hereby authorize the team coaches, or his representative, to secure emergency medical treatment for my child/ward if injured during practice or games.

*Players Name:

*Players School:

*Players Grade:

*Players Date of Birth:

Players Email Address:

Instructions

Please complete information for Parent/Guardian 1 below: (Required)

*Parent/Guardian Name:

*Parent/Guardian Phone Number:

*Parent/Guardian Email Address:

Instructions

Please complete information for Parent/Guardian 2 below: (Optional)

Parent/Guardian Name:

Parent/Guardian Phone Number:

Parent/Guardian Email Address:

Instructions

Complete the Emergency Information for the Player below:

Please list any medical or physical conditions the coaches should be aware of:

*Name of Insurance Provider:

*Policy Number:

*Players Physician:

*Physicians Phone Number:

*Emergency Contact (if parent cannot be reached):

*Emergency Contact Phone Number:

Instructions

I hereby grant Deerfield Young Warriors permission to use the above named players likeness in a photograph, video, or other digital media in any and all of its publications, including web-based publications, without payment or other consideration.

I Accept

Instructions

By selecting the “I Accept” button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting “I Accept” you consent to be legally bound by this Agreement’s terms and conditions.

*I Accept

Parental/Guardian Signature:

or cancel

Deerfield Young Warriors

Deerfield Young Warriors Registration and Release Form

Deerfield Young Warriors Registration and Release Form

Instructions

Instructions

Instructions

Instructions

Instructions

MAIN MENU