| Sport: Basketball Cheerleading Child's Name: Date of Birth: |
| Shirt Size: Gender: Male Female School Attending: |
| Address: City: State: Zip: |
Parent/Guardian Information |
| Mother: Email: |
| Home Phone: Cell Phone: Work Phone: |
| Address:
City:
State: Zip: |
Father: Email: |
| Home Phone: Cell Phone: Work Phone: |
| Address:
City:
State: Zip: |
| Emergency Contact:
Phone:
Alt Phone: |
Please select your top 3 preferred practice times (1 -3). All efforts will be made to accommodate preferences. However, schedule times will be primarily based on the coaches’ availability and the number of children registered.
First Choice:
Second Choice:
Third Choice:
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Please list any previous experience your child has had with the above-selected sport (YMCA, UPWARD, school/recreation leagues).
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Request for Permission: I, the above referenced youth athlete’s parent/guardian, hereby register my child to participate in The Edge Youth Sports program for the above listed sport(s).
Assumption of Risk: I acknowledge and understand that there is a risk of injury involved in athletic participation. I understand that my child will be under the supervision and direction of an Edgewood Baptist Church volunteer coach. I agree to follow the rules for the sport and instructions of the coach in order to reduce the risk of injury to my child and other athletes. However, I acknowledge and understand that neither the volunteer coach nor Edgewood Baptist Church can eliminate the risk of injury in sports. Injuries may and do occur. Sports injuries can be severe and in some cases may result in permanent disability or even death. I freely, knowingly and willfully accept and assume the risk of injury that might occur from my child’s participation in youth athletics.
Release: In consideration of Edgewood Baptist Church allowing my child to participate in youth athletics, I hereby agree to release, waive, discharge, covenant not to sue, hold harmless, and indemnify, on behalf of myself and any other parent or guardian of my child, Edgewood Baptist Church and its respective volunteer coaches, staff, and members from liability to us and our child as well as our personal representatives, assigns, heirs and next of kin, for any and all claims, suits or causes of action arising from or out of any injury, known or unknown, to property or body that my child may suffer from participation in Edgewood Baptist Church athletics, activities, or the above-described sports activities. |
| Insurance Company: Insurance Policy #: |
| Allergies, Asthma, or Other Conditions: |
| Parent/Guardian Name ("Signature"): Date: |
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