League Registration Form
Name of Participant *
Your answer
Pick the location you would like to join. *
Birthdate *
MM
/
DD
/
YYYY
Mailing Address *
Your answer
Email Address *
Your answer
Grade and School Name *
Your answer
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
T-shirt Size *
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Does your child have any allergies or medical conditions that staff should be aware of? *
Please list information regarding allergies and/or medical conditions about your child of which staff/volunteers should be aware.
Your answer
_____________ has my permission to participate in the Eastside Baptist Church/First United Methodist Church/Lighthouse Church/Surfside Middle School V4C Volleyball League. I also give permission for my child 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 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 for my child to participate, I understand that my child should be in good physical condition and that current medical exam is strongly recommended. I have listed information regarding allergies and/or medical conditions about my child of which staff/volunteers should be aware. *
Required
Insurance Company *
Your answer
Policy Number *
Your answer
Electronic Signature of Parent/Guardian *
Your answer
Submit
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