Girls Skills Training Clinic Application

Player and Parent Information Form

Click Here For Returning Player Application

Player's Name *
Player's Name
Date of Birth *
Date of Birth
Gender *
Parent / Guardian *
Parent / Guardian
Mother / Father
Parent / Guardian
Parent / Guardian
Father / Mother
Address *
Address
Phone *
Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Certification (Under Age 18, Minority Age Participants) *
I certify that I am the legal Parent/Guardian with legal responsibility for this participant, do consent and agree to his/her release provided above all releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, Even if arising from their negligence, to the fullest extent permitted by law.
Liability Waiver *
As legal guardian of the above named participant, I assume all risks and hazards incidental to such participation including transportation to and from activities, and do hereby waive. release, absolve, indemnify, and agree to hold harmless the local league organization, league players, and the organizers, sponsors, supervisors, participants, and persons transporting the participants to and from activities (if applicable) from any claim arising out of injury to the participant.
Parental Medical Authorization *
I give permission to managing personnel or other league officers or representatives, to authorize and obtain medical treatment from any licences physician, hospital, or medical clinic, should the player become ill or injured while neither parent/legal guardian or emergency contact is available to certify.
Photo Release *
I hereby give permission to SBNP to photograph, film, videotape my child (above participant) to reproduce and publish said images for promotional/marketing purposes.
Payment Option *
By typing my name in this box, I certify that all information on this form is accurate and truthful, and I adhere to all the above.