Sport Clubs: Non-Student Participation Waiver
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Email *
Club *
Personal Information
First Name *
Last Name *
Gender *
Phone Number *
XXX-XXX-XXXX format
Student ID Number
Birthdate *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Please identify your race: *
Required
University Information
University Status *
Required
Fee Status *
Required
Emergency and Medical Information
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship *
Health Insurance *
Required
Medical Insurance Company *
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