Learn to Play Clinic Registration: Atlanta 2019
1. Remember to print and bring the Medical Authorization form to the clinic,
http://www.usaultimate.org/assets/1/Page/Medical%20Authorization-V4.1.form.pdf.

2. By completing this registration form, you are signing the USA Ultimate Waiver, and you won't need to complete this USA Ultimate waiver on-site nor bring the completed USA Ultimate Waiver to registration.

3. DON'T FORGET TO CLICK THE SUBMIT BUTTON AT THE BOTTOM OF THIS FORM!

** If you aren't going to submit this online registration form, then you can also view, complete and print out the USA Ultimate Waiver here, https://www.usaultimate.org/assets/1/Page/2019%20USAU%20Waiver.pdf.

Email address *
What is the clinic participant's first name? *
Your answer
What is the clinic participant's last name? *
Your answer
What is the participant's date of birth? *
Your answer
What is the participant's current age? *
Your answer
What is the participant's gender? *
What is the participant's street address? *
Your answer
In which city does the participant live? *
Your answer
In which state does the participant live? *
Your answer
What is the participant's zip code? *
Your answer
What is the participant's approximate projected high school graduation date (month/year)? *
Your answer
What is the name of the school the clinic participant attends? *
Your answer
What is the parent or guardian's first and last name? *
Your answer
What is the parent or guardian's email address? *
Your answer
What is the parent or guardian's phone number? *
Your answer
What is the clinic participant's experience with ultimate? *
How did you hear about this Learn to Play Clinic? *
Please check all that apply.
Required
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to indemnify and hold harmless the releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs above, even if arising from their negligence, to the fullest extent permitted by law. *
By clicking 'Yes' below you are consenting to the USA Ultimate waiver. This means you won't need to complete this form at on-site or bring the completed USA Ultimate Waiver to registration. You do still need to have the participant bring the completed USA Ultimate Medical Authorization form to the clinic. A copy of this is listed at the end of registration. DON'T FORGET TO CLICK THE SUBMIT BUTTON AT THE BOTTOM OF THIS FORM!
Required
View USA Ultimate waiver by clicking on the below link.
2019 USA Ultimate Waiver
Remember to print and bring the USA Ultimate Medical Authorization form to the clinic (link below).
USA Ultimate Medical Authorization Form looks like this.
Please make sure to bring this completed form to the clinic.
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