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Parent Profile

Child Profile

Medical Background

Insurance Information

Physician Information

HIPAA

*See Notice of Privacy Practices*

I agree that I have received a copy of the Notice of Privacy Practices for the office of {Business Name}

Waiver

{Team Name} MEDICAL WAIVER/LIABILITY RELEASE In consideration for accepting the registration and permitting the voluntary participation of the above named child/children in its programs, I, the parent/guardian do hereby release, discharge and hold harmless {Team Name}, its volunteers and other representatives from all liability of any kind and character, and from any claim, demands, or cause of action which might be asserted on behalf of the above player against said organization, volunteers, and representatives. In the event of an emergency, and I am unavailable, I grant permission to said staff to administer first-aid and/or transport above child/children to the nearest medical facility for treatment.

Photo Release

Permission to Use Photograph Subject: I grant {Team Name}, its representatives and employees the right to take photographs of me and my children playing or cheering in {Organization Name}. I authorize {Team Name}, its assigns, and transferees to copyright, use and publish the same in print and/or electronically. I agree that {Team Name} may use such photographs of me and my player or cheerleader with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content

{Organization Name} REFUND POLICY

  • {Sample Policy 1} Refunds are only given in the case of full-event cancellation by {Organization Name}.
  • {Sample Policy 2} Refunds will have a $50 administrative fee taken out
  • {Sample Policy 3} No other refunds will be given

By signing this document I/We have read, understand and agree to comply with the Waiver as outlined above.

Payment Options

PAY ONLINE IN FULL: Submit total fees online today upon conclusion of this registration session via Visa, MasterCard, Discover, or checking account.

$350
$350
$350