CRUSH Registration Form
Name of Participant *
Birthdate *
MM
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DD
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YYYY
Mailing Address *
Email Address *
Grade and School Name *
Parent/Guardian Name *
Phone Number *
T-shirt Size *
Emergency Contact Name *
Emergency Contact Phone Number *
Does you have any allergies or medical conditions that staff should be aware of? *
Please list information regarding allergies and/or medical conditions the staff/volunteers should be aware.
_____________ has permission to participate in the high school league at Lighthouse Church. I also give permission to be photographed and for such photographs to be released for publicity purposes. In an emergency, I grant permission for emergency medical treatment to be administered. I agree to pay all medical bills not covered by my insurance company listed below. I release the Lighthouse Church and Volley for Christ and its staff and volunteers from responsibility for any bills resulting from injuries incurred in this program. While no sports physical is required to participate, I understand I should be in good physical condition and that a current medical exam is strongly recommended. I have listed information regarding allergies and/or medical conditions of which staff/volunteers should be aware. *
Required
Insurance Company *
Policy Number *
Electronic Signature of Parent/Guardian *
Submit
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