Summer Series insurance/waiver information
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Email *
Student/athlete participating name: *
High school program: *
Sport *
Grade level (class of): *
Street address: *
City: *
Zip code: *
Cell number: *
DISCLAIMER: I am the parent or guardian of the named participant in the Breakdown's Summer Series. I hereby give my approval to the participant in the scheduled activities of the event. I also assume all the risks and hazards to incidental contact or injuries and transportation. Breakdown Sports USA and The Breakdown is not responsible for any incidental hazard.
Site and date of event: *
Signature: *
Emergency contact phone number: *
Date: *
A copy of your responses will be emailed to the address you provided.
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