2019-2020 DEBATE TOURNAMENT REGISTRATION & PERMISSION FORM
This permission form covers your child’s participation in all 2019-2020 American Debate League programming including but not limiting to all Tournaments, Workshops, and Summer Debate Programs. To participate, please fill out and submit the student application form below. If you have any questions regarding this permission form, please contact Richard Connelly at 646-883-0123/e-mail americandebateleague@gmail.com

*American Debate League does not share, sell, rent or trade personally identifiable information with third parties for their promotional purposes.
Email address *
School Name
Your answer
Name of Debate Coach
Your answer
Participant Name
Your answer
Grade
Name of the Former School Attended (Elementary, Middle, High school)
Your answer
Parent Name
Your answer
Parent Phone Number
Your answer
Parent Email Address
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Emergency Contact Email Address
Your answer
Does the participant require any medications?
Your answer
Does the participant have any allergies?
Your answer
1. Permission to participate in the American Debate League
I do hereby consent that my child may participate in the stated activity, and in consideration for the American Debate League giving its time and supervision of such activity, do hereby personally on behalf of my child, absolve and release the American Debate League, its agents and volunteers from any claim of personal injuries which might be sustained by my child while participating in such activities, or while returning to his/her home.
2. Media Consent
I give permission for the American Debate League to use photographs, video, media of my child in our newsletters and promotional materials.
3. Health Information and Consent for Medical Treatment
Does the applicant have any allergies? (food, medication, etc.) *
Does the applicant have asthma? *
Does the applicant have special health care needs? *
Does the applicant take medication for any condition or illness? *
Please provide any additional health information details: *
Your answer
In the event of a medical emergency, I hereby give consent for necessary emergency medical treatment for my child to be obtained, with the understanding that I will be notified as soon as possible. I understand that every effort will be made to contact me, or, if I am unavailable, the emergency contact(s) listed., before and after medical care is provided *
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.
Your answer
Date
MM
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DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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