Scottsdale Wolves U16/High School Tackle Rugby - Registration

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Scottsdale Wolves U16/High School Tackle Rugby - Registration"

Transcription

1 First Name Scottsdale Wolves U16/High School Tackle Rugby - Registration Preferred Name / Nickname Last Name Date of birth (brackets based on age as of 9/1/2016) School (mandatory) Weight (lb) - mandatory Rugby Experience Primary Address Full Name Mobile Address Full Name Mobile Address (if dif) USA Rugby CIPP# (if known) Primary Cell Phone (if dif) Home (if dif) Home Indicate any medical or other issue the club should be aware of How did you find the club? Returning from previous year School Flyer Current/Previous club members Other rugby players Facebook Rugby Arizona site Looking for rugby on internet Additional Details:. Volunteering We are small and volunteer-based, which allows to keep our dues low and expose as many kids as possible to our great sport. Would you be interested in volunteering with the club? No experience is required, only enthusiasm! The club is split into squads, so you will be with your child. Squad Social Coordinator - coordinating snacks and social activities at games and outside of games. Club Social Coordinator - coordinating club-wide picnics and possibly other social activities. Other skills - Please notify us if you have other skills that you could offer to help the club. Fundraising: we are a non-profit 501c(3) club and work hard to keep the sport affordable. A big part of the club costs are covered through tax-exempt donations. Contact Joel Borie if you or your employer can help. Fill-in this registration form with the next 2 pages. Sign/initial all proper areas and mail with a $100 check (payable to Scottsdale Rugby) to: Joël Borie, 9102 E. Pershing Avenue, Scottsdale, AZ Players also need to register with USA Rugby to take part in practice and games ($60 in ) Scottsdale Wolves U16/High School Registration - Page 1/5

2 Scottsdale Wolves Rugby Football Club PERMISSION & RELEASE FORM PERMISSION TO PARTICIPATE, RELEASE, INDEMNITY and AUTHORIZATION FOR EMERGENCY MEDICAL AND DENTAL TREATMENT PERMISSION The undersigned parent(s) or legal guardian(s) of, hereby grant(s) permission for him/her to participate in the sport of rugby, and related activities, with the Scottsdale Wolves Rugby Football Club, a member of Scottsdale Rugby. In granting this consent, the undersigned understands and acknowledges the physical nature of the sport of rugby and the risks inherent in such physical activity. RELEASE AND INDEMNITY In consideration for the above player being permitted to participate in the activity specified above, the undersigned agree(s) to not make or join in a claim or civil suit for injury, death or property damage against Scottsdale Rugby or Rugby Arizona and their constituent bodies, the Arizona Rugby Referees Society and all affiliated entities, including, without limitation, their respective administrators, staff or volunteers participating in the above activity and hereby release(s) those entities, including, without limitation, their respective administrators, staff or volunteers, from all actions, claims and demands the undersigned or the player may hereafter have for injury, death or property damage, as consistent with public policy, arising out of participation in the activity specified above. Further, if a claim or civil suit is made or brought against Scottsdale Rugby or Rugby Arizona and their constituent bodies, the Arizona Rugby Referees Society and all affiliated entities, including, without limitation, their respective administrators, staff or volunteers as result of the actions of the above-named player for injury, death or property damage, the undersigned agree(s) to indemnity and hold harmless the aforementioned, including, without limitation, their administrators, staff or volunteers from any and all such claims, suits, damages, including judgments and/or settlements, whether such claims arise out of the negligence or intentional misconduct of the above-named player, whether such negligence is active or passive and whether individually or in concert with others. AUTHORIZATION The undersigned as parent(s) or legal guardian(s) of the above named minor player hereby authorize and grant to the supervising or a participating adult permission in the event of illness or injury while participating the activity specified above to consent to the following: any X- ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to the minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act or to consent to an X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by a dentist licensed under the provision of the Dental Practice Act. Said authorization to include the release of any medical or dental records to the attending physician or dentist for review. USE OF IMAGE OR LIKENESS I irrevocably authorize Scottsdale Rugby and Rugby Arizona to use for any lawful purpose, photographs and/or pictures of my image or likeness to be used in any website, newsletter, and any other marketing literature to be viewed by the public sector. I waive any right I have to inspect, approve all advertising or copies that may be used in connection with the publication of our website, newsletter, and/or any other marketing literature that may be viewed by the public sector. I have read, and fully understand this Release. I certify that I am 18 years old or if under 18 the parent/guardian fully understands the Release of the photographs to be used in Scottsdale Rugby and Rugby Arizona's website, newsletter, and any other marketing literature to be viewed by the public sector. Name of Player: Name of Parent/Guardian: Date: Signature of Parent/Guardian: Scottsdale Wolves U16/High School Registration - Page 2/5

3 Dear player and parents: Scottsdale Wolves High School Rugby Club Sign-Up Information and Forms Welcome to the Scottsdale Wolves High School Rugby Club and USA Rugby. This packet contains the basic information you need to provide and execute in order to participate in playing rugby with the Scottsdale Wolves High School Rugby Club and USA Rugby. Participation is very easy. All you need is a desire to learn and play rugby. We do have separate boys and girls teams. The Scottsdale Wolves are also part of a larger Scottsdale Rugby family. There is a youth program for boys and girls ages 6-14, and the Scottsdale Blues Men s Rugby Club. Safety is one of our primary objectives. All of our coaches are sufficiently trained, as well as registered and certified with USA Rugby. Prior to playing in a match you must meet some basic requirements. The Eligibility Requirements are: 1. Players must be under the age of 19 as of 9/1/16 (birth date not before 9/1/97). 2. Enrolled in school full time. 3. All participants at all levels must register with USA Rugby and obtain a CIPP Registration Number. Log on to click on Register, and make sure you register with Scottsdale Rugby Club-Boys HS. or Scottsdale Rugby Club-Girls HS. 4. Read, fill out completely, and turn in the Emergency Contact, Authorization of Consent To Medical Treatment For a Minor and the Code of Conduct forms. (Two page form attached to this packet). 5. Turn in a copy of your birth certificate or driver s license, and your school ID. 6. Pay Club Dues of $100. Checks should be made out to the Scottsdale Rugby Club. Shortly after payment of club dues the player will receive 1 pair of rugby shorts and 1 pair of rugby socks. Club dues are necessary to cover cost of jerseys, shorts, socks, post-match functions, fields, referees, some travel cost and other club costs. Club financial records are available to all players and parents upon request. 7. IRB approved cleats and a mouth guard are required. Additional gear may be obtained as desired. Almost all of our communication and coordination is done over the Internet. The main communication site is on Facebook. Our Group is Scottsdale Wolves High School Rugby Club (http://www.scottsdalewolvesfb.com). Our team website can be found at and the Scottsdale link on is an additional source of information. All changes of schedule will be posted on the web site generally by noon of each day. You can also contact Coach Jeremy Parenteau directly at with any questions. Welcome to the club, The Coaching and Administration Staff Scottsdale Wolves U16/High School Registration - Page 3/5

4 Scottsdale Wolves RFC EMERGENCY CONTACT AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT FOR A MINOR PLEASE PRINT S NAME AGE SEX PHONE SCHOOL GRADE List two persons to contact in case of Emergency: PARENT/GUARDIAN HOME PHONE WORK PHONE SECOND CONTACT HOME PHONE WORK PHONE Important Information INSURANCE COMPANY POLICY NUMBER PHYSICIAN S NAME PHONE ARE YOU ALLERGIC TO ANY DRUGS? IF SO, WHAT? ALLERGIES, IF ANY? (i.e., bee sting, dust) DO YOU SUFFER FROM ASTHMA? DIABETES? EPILEPSY? ARE YOU ON MEDICATION? IF SO WHAT? HAVE YOU HAD ANY CONCUSSIONS? IF SO WHEN? PREVIOUS INJURIES? IF SO, PLEASE LIST INJURIES AND WHEN? I, (parent or guardian) of the city of in the county of, Arizona, do hereby state that I am the natural parent or legal guardian having custody of, a minor, age, born, 19. In connection with my child s participation in rugby, I authorize any accompanying adult bringing my child to your treatment facility to consent to any x-ray, examination, anesthetic, medical, or surgical diagnosis or treatment, and hospital care to be rendered to the minor under the general or specific supervision, and on the advice of any physician or surgeon who is licensed to practice when the need for such treatment is immediate and when efforts to contact me are unsuccessful. I understand that I assume all liabilities and expenses for the above. I waive all claims against the above referred to adult, physicians, hospitals, and their employees, ambulatory care, etc. In connection with the decisions for such immediate care. SEE OTHER SIDE Scottsdale Wolves U16/High School Registration - Page 4/5

5 CODE OF CONDUCT As a member of the Scottsdale Wolves Rugby Club I agree to abide by the following code and to promote fair play and sportsmanship at all times towards coaches, teammates, opponents, and match officials. I also understand that I will be responsible for my actions and any consequences resulting from violation of this contract. 1. I realize that as a member of the team, we must all participate in all team practices, matches and meetings. I accept the responsibility of being at practice, on time, and making myself available for all matches, and meetings. I realize this means I have to take responsibility of staying out of trouble in general. I accept that if I do not follow this code, I may not be selected to a starting position for the next match. 2. The use or possession of tobacco, drugs, including steroids, or alcoholic beverages in any form will not be tolerated regardless of quantity. Any violation occurring at any time during the present season will result in a suspension for the rest of the season from the Scottsdale HS Rugby Football Club and from participating in the Rugby Arizona league. 3. The use of profane language is not acceptable and will not be tolerated. This includes directing language to opponents, coaches, match officials, and spectators. Violation can result in placement in the Sin Bin as instructed by the referee. Repeated offenses will result in my being sent out of the match and reports being sent to the Rugby Arizona State Based Rugby Organization (SBRO) for disciplinary action including suspension from play. 4. I agree to abide by the rules of play as set forth and explained in the text of the USARFU Handbook and Laws of the Game for the 2014/15 season. As the laws state in incidents of foul play i.e., fighting, taunting, or dangerous play, I will be subject to placement in the Sin Bin as instructed by the referee. Repeated offenses will result in my being sent out of the match and reports will be sent to the Rugby Arizona SBRO for disciplinary action including suspension from play. This Contract is in effect as of the signing date until the culmination of the current season to include playoffs and Championship matches. AS THE PARENT OF, I have read the above rules and I understand that my son/daughter will be governed by these rules as a player for the Scottsdale Wolves Rugby Football Club, the Rugby Arizona, and USA Rugby. Waiver and Release of Liability By signing this Contact Form, the player (if the player is at least 18 years old) or a player s parents/guardians (if the player is less than 18 years old) acknowledge that rugby is a fast paced sport involving vigorous contact among players, during both games and the preparation for games (together herein after referred to as rugby ), and that inherent in rugby are risks of significant physical injury, even paralysis or death. The player and the parents/guardians represent that they have read this release, understand its meaning, and, in order to participate in rugby, or have their minor children participate in rugby, voluntarily waive their own potential future claims. In consideration for enjoying the benefits of rugby, or for allowing the minor children to enjoy those benefits, the player (if at least 18 years) or the parent/guardian (if the players is less than 18 years) hereby assume all risks associated with participation in rugby, and hereby waive in advance all of their own claims against Rugby Arizona, the Scottsdale Wolves Rugby Football Club, sponsoring persons and organizations, coaches, officials, other players (on any team), their parents, and the persons owning or providing the space for rugby (herein after together referred to as releasees ), and agree to hold harmless and indemnify the releasees regarding any claim belonging to the player (if at least 18 years) or to the parent (if the player is less than 18 years) premised upon any injury to a player, or to the parent/guardian, caused in whole or in part by any action or inaction by a releasee (including a releasee s negligence), in connection with rugby, with travel to or from rugby, or with rugby-oriented social activities sponsored or hosted by a releasee. Scottsdale Wolves U16/High School Registration - Page 5/5

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT DOMESTIC OVERNIGHT TRAVEL/INHERENT DANGER DESTINATION:

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT DOMESTIC OVERNIGHT TRAVEL/INHERENT DANGER DESTINATION: RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT DOMESTIC OVERNIGHT TRAVEL/INHERENT DANGER DESTINATION: Schreiner University (SU) allows Participants to participate in Participant

More information

Cornerstone Christian School Athletic Packet 2014-2015

Cornerstone Christian School Athletic Packet 2014-2015 Cornerstone Christian School Athletic Packet 2014-2015 TWELVE VIRTUES FOR THE STUDENT-ATHLETE Athletics serve as an integral piece to the total educational program found at Cornerstone Christian School.

More information

Math + Leadership Camp at CSUSM Registration Forms

Math + Leadership Camp at CSUSM Registration Forms Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of

More information

Name Grade DOB Male/Female. Nickname School: Primary Address: Secondary Address: Youth . Youth Home Phone Youth Cell Phone.

Name Grade DOB Male/Female. Nickname School: Primary Address: Secondary Address: Youth  . Youth Home Phone Youth Cell Phone. Christ Church Youth Ministry 2012-2013 Universal Permission Form Effective Dates: September 1, 2012 August 31, 2013 YOUTH INFORMATION Name Grade DOB Male/Female Nickname School: Primary Address: Secondary

More information

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

2016 Enrolment Forms

2016 Enrolment Forms 2016 Enrolment Forms Student Details First Name: Last Name: Suburb: Post Code: Date of Birth: Age: Male/Female: Phone Number (M): (H): Email: Parent Details Mother/Guardians Name: Mother/Guardians Phone

More information

LACEY ROLLER HOCKEY P.O. BOX 170 LANOKA HARBOR, NJ HOTLINE: WEBSITE:

LACEY ROLLER HOCKEY P.O. BOX 170 LANOKA HARBOR, NJ HOTLINE: WEBSITE: LACEY ROLLER HOCKEY P.O. BOX 170 LANOKA HARBOR, NJ 08734 HOTLINE: 609-242-2215 WEBSITE: WWW.LACEYROLLERHOCKEY.COM Welcome Lacey Roller Hockey Participants to the 2016 Spring Season. We are looking forward

More information

Motorcycle RiderCourse WAIVERS

Motorcycle RiderCourse WAIVERS Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State

More information

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail.

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail. OUR CAMPS ARE FOR GIRLS AND BOYS (AGES 5 THRU 14) Visit our website at Junior Golf Camp (9:00am 12:30pm) We start camp early (8:45am) on Monday for check-in and orientation. The camp is designed for beginners

More information

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City:

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City: Please mail application to: Las Campanas Compadres, Inc. 15 Buckskin Circle Santa Fe, NM 87506 Fax: 505 820 2709 Las Campanas Compadres, Inc. Student Application Form Please be sure to sign the waiver

More information

Release of Liability. Printed Name of Participant:

Release of Liability. Printed Name of Participant: Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

Eastern Region Youth Consultant Salem, Virginia 24153 jaharden@comcast.net 540 375-3191

Eastern Region Youth Consultant Salem, Virginia 24153 jaharden@comcast.net 540 375-3191 UNITY WORLDWIDE MINISTRIES EASTERN REGION Jane Harden 1865 Laurel Mountain Dr Eastern Region Youth Consultant Salem, Virginia 24153 jaharden@comcast.net 540 375-3191 December 16, 2014 Dear Y.O.U. Sponsors,

More information

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code:

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code: Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code: Contact Name: Emergency Contact Number: Alt. Emergency Contact Number: E-Mail Address: Alt. Contact Name: Check

More information

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program.

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program. VALOR Before/After School Program School Year 2016-2017 Mar Vista Academy Enrollment Form and General Release for the Before/After School Program State and Federal Programs Student First Name Middle Name

More information

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, the undersigned, on behalf of my minor child: ( Participant ), hereby acknowledge that Participant has

More information

Join the Future Inspired Native American Leaders!

Join the Future Inspired Native American Leaders! Join the Future Inspired Native American Leaders! What is it? An exciting program that prepares American Indian high school youth to become college and career ready and learn about their culture! Who is

More information

Woodland Cal Ripken Youth Baseball

Woodland Cal Ripken Youth Baseball Woodland Cal Ripken Youth Baseball 725 Main Street Suite 11, Woodland CA 95695 (530) 666-0731 www.woodlandcalripken.com REGISTRATION FORM - SPRING 2016 Player s Name: Date of Birth: Parent/Guardian: Address:

More information

GATEWAY DISCOVERY CAMP

GATEWAY DISCOVERY CAMP GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.

More information

NEW STUDENT REGISTRATION

NEW STUDENT REGISTRATION NEW STUDENT REGISTRATION High Performance: Academy Prep: Early Childhood: $20.00 registration fee (includes 2 Academy T-shirts) $20.00 registration fee (includes 2 Academy T-shirts) $10.00 registration

More information

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION 2015-2016 SEASON MEMBERSHIP APPLICATION MEMBER INFORMATION: BACK TAG # ISSUED: MEMBER NAME: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CEL #: E-MAIL ADDRESS: (Please send newsletter via: Mail E-Mail ) DATE

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

Field Trip, Offsite Tutoring and Transportation Policy

Field Trip, Offsite Tutoring and Transportation Policy Field Trip, Offsite Tutoring and Transportation Policy This policy is intended to protect the safety of School on Wheels, Inc. (SOW) students and volunteers while participating in field trips, offsite

More information

SANTA PAULA HIGH SCHOOL Sports/Co-curricular Participation Screening Examination

SANTA PAULA HIGH SCHOOL Sports/Co-curricular Participation Screening Examination Sports: Student ID#: SANTA PAULA HIGH SCHOOL Sports/Co-curricular Participation Screening Examination Name Birth Date Current Grade Home Address Home Phone Parent(s)/Guardian(s) Name Have you ever (Circle

More information

Personal Medical Conditions. Obligation Regarding Own Medical Insurance. Participation In This Activity Is Voluntary.

Personal Medical Conditions. Obligation Regarding Own Medical Insurance. Participation In This Activity Is Voluntary. Personal Medical Conditions It is your responsibility to check with a medical doctor to see if you (or your ward) have any medical or physical conditions which would preclude or limit your participation

More information

VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, ( Volunteer ), desire to participate as a volunteer athletic coach in the ( Program ) on. I acknowledge

More information

Backcountry Outdoor Adventure Camp

Backcountry Outdoor Adventure Camp Backcountry Outdoor Adventure Camp Get outdoors. Connect with nature. Focused on combining a passion for biology, conservation, and ecology with outdoor recreation. Registration Packet is due by: Registration

More information

2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM HELD ON SILVER STRAND BEACH IN OXNARD

2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM HELD ON SILVER STRAND BEACH IN OXNARD 2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM HELD ON SILVER STRAND BEACH IN OXNARD Dear Junior Lifeguard Families and prospective Junior Lifeguards: Enclosed is your 2016 PROGRAM OUTLINE. Please retain

More information

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Academy would like to extend an invitation to play soccer with our Inter Academy Program. We are very excited about the upcoming season.

More information

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information

More information

Camper Information Form

Camper Information Form Camper Information Form NO CAMP HELD ON JULY 4, 2016 Please Mark Dates Attending: Session 1: June 27 July 8 Session 2: July 11 July 22 Session 3: July 25 August 5 ALL 3 SESSIONS Personal Information Name

More information

Mid-States Football League Rules and Regulations. Mid-Kansas Central Division

Mid-States Football League Rules and Regulations. Mid-Kansas Central Division Mid-States Football League Rules and Regulations Mid-Kansas Central Division Revised August 2006 Article 1. GENERAL PURPOSE To teach boys and girls with such fundamentals of football as blocking, tackling,

More information

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM NOTICE: ALL ATHLETES WILL BE REQUIRED TO HAVE A SIGNED CONSENT FORM BEFORE TAKING THE FIELD. Football Camps of America, LLC. Parental Release Physical Form Waiver

More information

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET School / Team: Name: Address: City, State, Zip: Home Phone: Cell Phone: Email: (please circle your responses) Do you attend the above named

More information

2015 Coach E s Flagler College Basketball Camps

2015 Coach E s Flagler College Basketball Camps 2015 Coach E s Flagler College Basketball Camps Necci Brown 2015 Averaged a 31.9 field goal percentage during her career as a Saint July 13-17 Camp Registration Campers cannot be admitted without full

More information

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT This contract is to be signed by both the participant (child) and his or her parent/guardian. This ensures that both the child and the adult understand

More information

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP: Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as

More information

Southern California Men's Collegiate Gymnastics Association

Southern California Men's Collegiate Gymnastics Association SC United Application 2016 Packet www.facebook.com/socalcollegegymnast @SCUgymnastics southerncaliforniaunited scugymnastics SC United Team Application Instructions Thank you for your interest in the SC

More information

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds

More information

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ) the undersigned student wish to participate in a study abroad Program offered by Saint Louis

More information

2016 SCS Diversity Select Camp

2016 SCS Diversity Select Camp 2016 SCS Diversity Select Camp May 7 th, 2016 8:30am-5:00pm A One Day Camp Cost: $25 Columbia, SC The USC Pool Solomon Blatt Center Applications are to be received no later than Thursday, March 31, 2016

More information

INTERNATIONAL LEADERSHIP OF TEXAS

INTERNATIONAL LEADERSHIP OF TEXAS INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS

More information

Recreation & Community Services Camp Serendipity Summer Day Camp 2016

Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Camp Phone & Address Performing Arts Center (Youth Center) 800 Hobson Way (805) 385-8168 (Camp Site) (805) 890-6321 (Camp Site Cell)

More information

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com 2009/2010 Policy Agreement I have received a copy of the 2009/2010 studio policy and current class schedule. I agree to adhere to all studio policies as contained in this document and explained to me.

More information

Indemnity to ERC, and to Minor Release

Indemnity to ERC, and to Minor Release Universal Release of Liability This is a release of claims, a waiver of liability, an assumption of risk, and an indemnity agreement. By signing this document, you will irrevocably waive and release certain

More information

LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB

LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB 2016 PLAYER REGISTRATION PACKAGE Welcome to the Grenadiers Football Family! Enclosed in this handbook is the information that will help you prepare for your

More information

REGISTRATION & MEDICAL FORM

REGISTRATION & MEDICAL FORM REGISTRATION & MEDICAL FORM NAME ADDRESS CITY PROV POSTAL TELEPHONE E-MAIL CLUB BIRTH DATE DD/ MM / YYYY AGE (on Dec. 31, 2011) GENDER: M F MB MEDICAL # For Office Use Only: Plate number: Category: Amount

More information

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians,

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians, Dear Parents and Guardians, In order to simplify and provide better service to everyone, Rancho Simi Recreation and Park District ( the District ) has implemented the following payment processing procedures

More information

Registration Form. Child s Name: Grade: Age:

Registration Form. Child s Name: Grade: Age: Parent s Name: Address: Email Address: Cell Phone: Emergency Contact Name: Registration Form Home Phone: Number: Child s Name: Grade: Age: School Name: Gender: Male: Female: T-Shirt Size: Small: { } Medium:

More information

Community House High School Programs Standing with families since 1969

Community House High School Programs Standing with families since 1969 Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster

More information

Annual Field Trip Forms

Annual Field Trip Forms Annual Field Trip Forms Dear Parents: We are excited about the field trips planned for this year. They have a significant role in your child s education. In an effort to provide safe field trips for your

More information

2013 Mid-West Collegiate Championships February 9, 2013

2013 Mid-West Collegiate Championships February 9, 2013 2013 Mid-West Collegiate Championships February 9, 2013 Host: Purdue Judo Club Location: Purdue University Sanction: USA Judo Recreational Sports Center Indiana Judo Inc. 355 N. Martin Jischke Drive West

More information

Back-Up Care Advantage Program Registration Materials

Back-Up Care Advantage Program Registration Materials Registration Materials Dear Parent, Welcome to the Back-Up Care Advantage Program! An important part of preparing for a day of back-up care is ensuring that your care provider will have the information

More information

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661 Thank you for your interest in the Apex Police Department Law Enforcement Explorer Program. Please complete the following steps so we are able to process your application. Fill out the application completely

More information

POLICE ATHLETIC LEAGUE

POLICE ATHLETIC LEAGUE POLICE ATHLETIC LEAGUE The Police Athletic League (P.A.L.) is a recreation-oriented juvenile crime prevention program that relies heavily on athletics and recreational activities to create and cement the

More information

Name: Grade: Age: Answer the following questions as accurately as possible. (Explain yes answers below.) SINCE YOUR LAST PHYSICAL EXAMINATION: Yes No

Name: Grade: Age: Answer the following questions as accurately as possible. (Explain yes answers below.) SINCE YOUR LAST PHYSICAL EXAMINATION: Yes No TRUMANSBURG CENTRAL SCHOOL SPORTS CANDIDATE QUESTIONNAIRE This packet needs to be filled out within 30 days from the beginning of the season and turned into the nurse no later than 1 week prior to the

More information

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development

More information

Garrett Middle School Athletic Handbook 2015-16

Garrett Middle School Athletic Handbook 2015-16 Garrett Middle School Athletic Handbook 2015-16 1 Athletic Department Philosophy It is the intent of Garrett Middle School to encourage and allow athletic participation while maintaining academic integrity

More information

Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) INFORMED CONSENT/INSURANCE NOTICE

Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) INFORMED CONSENT/INSURANCE NOTICE Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) Did you play for Kendall United last year? Yes No Member s Last Name: Member s First

More information

Bartow County C.E.R.T.

Bartow County C.E.R.T. Dear Applicant, I would like to take this opportunity to thank you for your interest in the Community Emergency Response Team. The CERT Program is presented by the Bartow County Emergency Management Agency

More information

2015 RACE REGISTRATION packet

2015 RACE REGISTRATION packet 2015 RACE REGISTRATION packet First annual Delaware Charity Challenge Saturday, May 2, 2015 Lums Pond State Park Bear, Delaware delawarecharitychallenge.com Saturday, May 2, 2015 Lums Pond State Park 2015

More information

CAMP MSC SENSATIONAL SUMMER SCIENCE

CAMP MSC SENSATIONAL SUMMER SCIENCE CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day

More information

Tackle Football and Cheerleading

Tackle Football and Cheerleading Cooper City Optimist ("CCO") Bylaws Tackle Football and Cheerleading 1- Organization (Name) The organization shall be known as the Cooper City Optimist Football, "CCOF" or "Program", CCOF operates on a

More information

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships HOST: ELIGIBILITY: Texas A&M University Judo Team http://aggiejudo.com Texas, Oklahoma, Louisiana, Arkansas, Mississippi & New Mexico full time college students. See eligibility requirements on page 3

More information

Please read the waiver carefully. If you have any questions or concerns contact registration@aiusa.org.

Please read the waiver carefully. If you have any questions or concerns contact registration@aiusa.org. Amnesty International USA sponsors special enrichment events for youth leaders as a means of providing a comprehensive and diverse learning environment to further their understanding of and participation

More information

FORREST COLLEGE CHILD CARE. Handbook

FORREST COLLEGE CHILD CARE. Handbook FORREST COLLEGE CHILD CARE Handbook MISSION STATEMENT We are privileged at Forrest College to provide free child care for the children of our fulltime students. It is our aim to provide a safe and structured

More information

ATHLETIC PARTICIPATION MEDICAL PACKET (SOPHOMORES)

ATHLETIC PARTICIPATION MEDICAL PACKET (SOPHOMORES) ATHLETIC PARTICIPATION MEDICAL PACKET (SOPHOMORES) Dear Weatherford College Athlete, Athletic Training & Sports Medicine A new year of Weatherford College Athletics is quickly approaching. I hope this

More information

Personal History Statement Application for Law Enforcement Explorer

Personal History Statement Application for Law Enforcement Explorer Name: Date Applied: Personal History Statement Application for Law Enforcement Explorer The Plano Police Department Explorer Post 911 909 14 th Street Plano, Texas 75086-0358 Instructions Read these instructions

More information

Address: Street City State Zip Code Home Phone: E-mail Address:

Address: Street City State Zip Code Home Phone: E-mail Address: SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First

More information

CAMP MSC SENSATIONAL SUMMER SCIENCE

CAMP MSC SENSATIONAL SUMMER SCIENCE CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day

More information

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition. California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

More information

Extracurricular Activities Handbook

Extracurricular Activities Handbook Extracurricular Activities Handbook Board Approved July 16, 2007 EXTRA-CURRICULAR STUDENT ACTIVITIES HANDBOOK Philosophy and Definition Extra-curricular activities are school-sponsored activities that

More information

Hope s Youth Ministry High School Retreat

Hope s Youth Ministry High School Retreat Hope s Youth Ministry High School Retreat March 6-8, 2015 Pocono Plateau Cresco, PA Hope s Youth Ministry PO BOX 914, 700 Cooper Rd. Voorhees, NJ 08043 Questions or for further information: dave@meethope.org

More information

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program:

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program: Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5 Respite Program: Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth

More information

Tech Judo Open II Invitational Judo Tournament

Tech Judo Open II Invitational Judo Tournament Tech Judo Open II Invitational Judo Tournament USA Judo Sanction # 2015-12-02 Date: Sunday, February 15, 2015 Tournament Director: Clyde Worthen Tournament Coordinator: Leonardo Victoria Head Referee:

More information

Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program!

Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program! Greetings! Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program! These waiver forms must be completed and submitted in order for your application

More information

TUITION RATES SCHOOL YEAR 2015-2016

TUITION RATES SCHOOL YEAR 2015-2016 TUITION RATES SCHOOL YEAR 2015-2016 REGISTRATION FEE: $65.00 per child DISCOUNTS: Family discount apply to families with two or more children in the Extended Day program. Full price is paid for the youngest

More information

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 ASSUMPTION AND ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY WAIVER 1. ALL OF THE UNDERSIGNED, DO HEREBY AFFIRMATIVELY

More information

IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION

IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION TO BE ELIGIBLE FOR THE INSURANCE RATES ON THE FOLLOWING PAGE For fast service fax completed

More information

Barstow Judo Club Invitational Judo Tournament

Barstow Judo Club Invitational Judo Tournament Barstow Judo Club Invitational Judo Tournament Date: Sunday June 24, 2012 Location: Eligibility: Entry Fee: Awards: Sanction: Cora Harper Community Center 841 Barstow Road Barstow, CA 92311 MUST BE Current

More information

Western Brown Youth Football & Cheerleading A Non-Profit Organization

Western Brown Youth Football & Cheerleading A Non-Profit Organization HEAD COACH REGULATIONS WBYFC will review all applications and interview each of the potential candidates. The Executive Board will then vote on each applicant according to our Coaches Policies. Each Head

More information

Taishi Judo Club 5 th Annual Invitational Tournament

Taishi Judo Club 5 th Annual Invitational Tournament Taishi Judo Club 5 th Annual Invitational Tournament Date/Time: Location: Sunday, March 22, 2015. Tournament will start promptly at 10:00AM Northview High School 1016 W. Cypress St. Covina, CA 91722 Sanction:

More information

WICOMICO COUNTY ATHLETIC PACKET

WICOMICO COUNTY ATHLETIC PACKET Emergency Form and Medical History LAST NAME: FIRST: M.I. SEX: MALE FEMALE Date of Birth: / / Sports: Grade: School: SSN: Parent/Guardian Home Phone Cell Phone Work Phone Emergency Contact-In the event

More information

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures:

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures: INSTRUCTIONS FOR COMPLETING REGISTRATION 1. Print out the Waiver of Liability, Medical Release Form and Participant Information Sheet attached to this document 2. Fill out the forms completely with necessary

More information

La Salle College High School Junior Summer Service Immersion Application. Instructions

La Salle College High School Junior Summer Service Immersion Application. Instructions La Salle College High School 2016 Junior Summer Service Immersion Application Instructions *** Due in Campus Ministry no later than Wednesday, November 18, 2015 *** Thank you for your interest in La Salle

More information

Wildwood Crest Dolphin Swim Team REGISTRATION FORM. (Circle One): Blue Team White Team Orange Team. SWIMMER S NAME (Last, First, Middle): AGE: DOB:

Wildwood Crest Dolphin Swim Team REGISTRATION FORM. (Circle One): Blue Team White Team Orange Team. SWIMMER S NAME (Last, First, Middle): AGE: DOB: REGISTRATION FORM (Circle One): Blue Team White Team Orange Team SWIMMER S NAME (Last, First, Middle): AGE: DOB: PARENT/GUARDIAN NAME: STREET ADDRESS: CITY/STATE/ZIP: HOME TELEPHONE: WORK TELEPHONE: CELL

More information

Cherry Blossom Open XXII

Cherry Blossom Open XXII Cherry Blossom Open XXII Saturday, February 13, 2016 National Ranking Points: Bantam, Intermediate, & Juvenile A & B only - 2 for 1st, 1 for 2nd, and.5 for 3rd Hosted by: Tomodachi Judo Club & Ki-Itsu-Sai

More information

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council Date / Time: Sunday, August 10, 2014 / Kata Competition 9:00 AM - Shiai Competition 10:00 AM Location: Long Beach Pyramid-California State University, Long Beach 1250 Bellflower Blvd., Long Beach, CA 90840

More information

Schooling For Life GIFTED ENRICHMENT PROGRAM

Schooling For Life GIFTED ENRICHMENT PROGRAM GIFTED ENRICHMENT PROGRAM PHONE: (805) 242-8363 Email: contact@schoolingforlife.org Website: www.schoolingforlife.org Address: P.O. Box 92782 Pasadena, CA 91109 1 Welcome to s Enrichment Program! We look

More information

GENERAL RECOMMENDATION

GENERAL RECOMMENDATION GENERAL RECOMMENDATION Release Authorization Your application will be held until we receive this form. RELEASE AUTHORIZATION To Be Completed by Student Student Signature Student Name Address t/ y/ e/zip)

More information

Registration Form. Full Name. Address. Phone Numbers (H)

Registration Form. Full Name. Address. Phone Numbers (H) Registration Form Parent Information Parent 1 Full Name Address Phone Numbers (H) (C) (W) E-mail Address *Would you like to receive e-mails to this email address about special promotions/events at The

More information

Oberlin Dance Intensive

Oberlin Dance Intensive Oberlin Dance Intensive July 6-11, 2014 For Ages 14-18 Early Registration Deadline: March 1, 2014 = $585 tuition Regular Registration Deadline: April 10, 2014 = $625 tuition Email completed registration

More information

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach)

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) (Agency/Instructor/Coach) hereby agrees to defend, indemnify and

More information

The Ruben Martin Open Judo Championships

The Ruben Martin Open Judo Championships The Ruben Martin Open Judo Championships Sponsored by: ROUND ROBIN FOR DIVISIONS OF 5 OR LESS TRUE DOUBLE ELIMINATION FOR 6 OR MORE AT LEAST 3 MATCHES FOR MOST JUNIORS JUNIOR NOVICE DIVISIONS (up to one

More information

Registration Details

Registration Details Registration Checklist Please bring this form with you to registration Completed Registration Contract (pg. 2) Read and Sign Terms & Conditions/Liability Form (pg. 3) Completed Medical Forms (pg. 4) USA

More information

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male

More information

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902)

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) SCHEDULE OF EVENTS A LOCATION s Friday, May 1, 2009 (Midway Judo Club) 6:00 PM 8:00 PM Referee s Clinic ($10.00 fee

More information

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage-

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Name of Organization: C/O (Individual Responsible for Insurance): Mailing : City: State: Zip: Phone: ( ) Fax: ( )

More information

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 This insurance program is available for amateur teams & leagues that are members

More information

Learning 2 Mastery After-School Reading and Math Program Parent Packet

Learning 2 Mastery After-School Reading and Math Program Parent Packet Parent Packet 700 Pelham Road North, Jacksonville AL 36265 Dear Parents! Welcome to a new and exciting time with the Learning 2 Mastery program. The hours of operation during the program are 3:15 p.m.

More information