Request edit access
The Brooklyn Ripple 2019 Sports Summer League
Welcome to The Brooklyn Ripple sports summer league. The Brooklyn Ripple was founded in 2018 on four core values- Authenticity, Joy, Inclusion and Empowerment. Our Mission is to create and inspire through recreational services and product. Please complete this form fully, submission of an application does not guarantee enrollment in the program.
If accepted, program will be $99 annual registration fee and $375 weekly .
For the purpose of this application, applicant refers to the person applying to The Brooklyn Ripple Sports Summer League. Select one: *
How will you be paying ? *
Required
Please check all weeks your child will be attending *
Required
Applicants First Name *
Your answer
Applicants Last Name *
Your answer
Applicants Date of Birth *
MM
/
DD
/
YYYY
Applicants T-Shirt size *
Applicants Gender *
Applicants Race (optional)
Applicants Primary Address *
Your answer
Parent/Guardian Information
This section is required for Applicants under 18
Parent/Guardian Name *
Your answer
Relationship to Applicant *
Your answer
Telephone Number (Home) *
Your answer
Telephone Number (Cell) *
Your answer
Telephone Number (Work) *
Your answer
Email Address *
Your answer
Parent/Guardian Address *
Your answer
Emergency Contact Information
At least one Emergency Contact must be Identified.
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Relationship to Applicant *
Your answer
Emergency Contact #1 Number/s *
Your answer
Emergency Contact #1 Email *
Your answer
Authorized to pick up child? *
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Relationship to Applicant *
Your answer
Emergency Contact #2 Number/s *
Your answer
Emergency Contact #2 Email *
Your answer
In the event that I or my listed contacts cannot be reached in an emergency, I hereby give permission to hospital or ambulatory personnel to administer the treatment deemed necessary to assist my child. *
Your typed name in the space below indicates your consent.
Your answer
Authorized to pick up child? *
Your typed name in the space below indicates your consent for your child to be self released.
Your answer
The following additional people are authorized to pick up my child:
Name, Number & Relationship #1 *
Your answer
Name, Number & Relationship #2 *
Your answer
Name, Number & Relationship #3
Your answer
The Following People May Not Pick Up My Child *
Your answer
Applicant's Education Status 2018-2019 school year *
Part Time or Full Time Students, 2018-2019 School Year. Please select Grade *
School Name *
Your answer
School Address *
Your answer
Do you have experience in any of the 2019 summer league sports ? (list sports and skill level if none state none ) *
Swimming, Cross country track , Flag football, Softball, Basketball, Soccer, Volleyball, Tug of war, Spikeball or Kickball.
Your answer
Health Information
Applicant’s Health Information
Please answer the questions below and provide additional details in the space provided. Many needs or health challenges can be accommodated and may not limit enrolment in the program.
Does the applicant have any allergies? *
If the answer was YES, please provide more information
Your answer
Does the applicant suffer from asthma? *
Does the applicant have special health care needs? *
If the answer was YES, please provide more information.
Your answer
Does the applicant take medication for any condition or illness? *
If the answer was YES, please provide more information
Your answer
Are there activities the applicant cannot participate in? *
If the answer was YES, please provide more information
Your answer
Please provide any additional health information details. *
Your answer
Consent and Signature
My child has permission to travel home alone at dismissal *
Do you need transportation? $50 per household of up to 4 children. Please add which week and children’s names below.
Your answer
Your typed name in the space below indicates your consent for your child to be self dismissed. *
Your answer
Consent for Photography/Videotaping and Use of Original Work. As a participant enrolled in The Brooklyn Ripple Sports Summer League, please be aware in some cases, we may photograph, videotape, or otherwise record students , with or without their name, in printed and electronic media such as brochures, books, print and newsletters, and The Brooklyn Ripple LLC websites, social media (collectively, “Media”). I hereby authorize and permit The Brooklyn Ripple LLC , without compensation and without further approval, to photograph and/or record my an child’s image, name, likeness, and the sound of my child’s voice during activities, and special events, and I hereby consent to the resulting images, videos and interviews being used, without compensation and without further approval. *
Your typed name in the space below indicates your consent.
Your answer
If, in the course of participating in The Brooklyn Ripple Sports Summer League program activities and special events, any original work such as art, choreography, poetry, or prose (collectively, “Original Work”) is created by me or my child, I hereby consent to such Original Work being used The Brooklyn Ripple without compensation and without further approval, solely for non-profit, non-commercial purposes in any and all Media. *
Your typed name in the space below indicates your consent.
Your answer
As the legal parent or guardian, I release and agree to hold harmless The Brooklyn Ripple LLC, its officers, directors and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of The Brooklyn Ripple LLC, its directors, partners and service providers. Your typed name in the space below indicates your agreement. *
Your answer
How did you hear about us? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service