Please enter information carefully. Required fields are marked with *.
PLAYER/CHEERLEADER INFORMATION
Last Name
*
Name Child Goes By
Street Address
*
City
*
Age on July 31st
*
Insurance Carrier
Policy Number
Allergies or Known Medical Conditions
*
Any Special Needs or Concerns for the Childs Coach?
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 First Name
*
Parent/Guardian #1 Last Name
*
Parent/Guardian #1 Address
*
Parent/Guardian #1 City
*
Parent/Guardian #1 Home Phone
*
Parent/Guardian #1 Work Phone
*
Parent/Guardian #1 Cell Phone
*
Email
*
Parent/Guardian #2 First Name
Parent/Guardian #2 Last Name
Parent/Guardian #2 Address
Parent/Guardian #2 City
Parent/Guardian #2 Home Phone
Parent/Guardian #2 Work Phone
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 email
MEDICAL/EMERGENCY CONTACT
Emergency Contact Phone
*
WAIVER INFORMATION
I, AS PARENT/GUARDIAN OF THE ABOVE LISTED CHILD, DO HEREBY GRANT, IN MY ABSENSE, THE AUTHORITY TO THE COACHING STAFF OF THE LIONS ORGANIZATION TO RENDER JUDGEMENT CONCERNING MEDICAL ASSISTANCE OR SURGICAL DIAGNOSIS AND TREATMENT WHICH MAY BE DEEMED NECESSARY.
I HEREBY WAIVE AND HOLD HARMLESS ANY AND ALL LIONS STAFF AND ANY OTHER LEAGUE OFFICIAL WORKING IN CONJUNCTION WITH ANY AND ALL FACILITIES AND TRANSPORTATION VEHICLES THE LIONS DEEM NECESSARY TO USE, WHETHER PAID OR VOLUNTEER, FOR ANY INJURIES, CLAIMS, OR DAMAGES.
I UNDERSTAND, AS WITH ANY ATHELETIC ACTIVITY, PARTICIPATION CREATES THE POSSIBILITY OF ACCIDENTAL INJURY, INCLUDING CATASTROPHIC INJURY OR DEATH.
I HAVE READ AND UNDERSTAND THE RISK INVOLVED WITH MY CHILDS'/WARDS' PARTICIPATION IN THE LIONS ORGANIZATION.
I HEREBY GIVE CONSENT AND WISH TO HAVE MY CHILD ENROLLED AND ACTIVELY PARTICIPATE IN THE LIONS ORGANIZATION.
