New York Red Wings Application 2017
Athlete Registration Form
Email address *
Athlete's First Name *
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Athlete's Last Name *
Your answer
Athlete's Street Address *
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Athlete's City, Town or Village *
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Athlete's State *
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Athlete's ZIP Code *
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Athlete's Date of Birth *
MM
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DD
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Athlete's Gender *
Athlete's School *
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Athlete's Grade *
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Parent or Guardian 1 First Name *
Your answer
Parent or Guardian 1 Last Name *
Your answer
Parent or Guardian 1 Mobile Number
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Parent or Guardian 1 Work Number
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Parent or Guardian 1 Home Number
Your answer
Parent or Guardian 2 First Name
Your answer
Parent or Guardian 2 Last Name
Your answer
Parent or Guardian 2 Email
Your answer
Parent or Guardian 2 Mobile Number
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Parent or Guardian 2 Work Number
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Parent or Guardian 2 Home Number
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Healthcare Insurance Carrier
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Healthcare ID Number
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Known Allergies
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Other Information We Should Know
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What other sports will your child be playing this Spring?
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Has your child played AAU Bacsketball before? If so, with which team(s)?
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Uniform Jersey Size
Uniform Shorts Size
Tshirt Size
Waiver and Electronic Signature *
TYPING YOUR NAME IN THE BELOW BOX SERVES AS YOUR ELECTRONIC SIGNATURE TO THE FOLLOWING WAIVER. I, the undersigned Parent/Guardian of the above-named minor child, do hereby assume all risks and hazard incidental to such participation in basketball with the New York Red Wings including transportation to and from said activities and hereby waive, release, absolve, the organizers, sponsors, operators, supervisors, trainers, coaches, assistant coaches, coordinators, assistant coordinators, and other participants directly or indirectly involved in such activities from any claims arising out of injury to the athlete named here above.I understand travel can be extensive. I agree to direct my child to cooperate and comply with reasonable directions and instructions from adult coaches. I agree to be responsible for all medical expenses relating to injury of my child as a result of his/her participation in basketball with the New York Red Wings, whether or not caused by the program volunteers and coaches or other participants. I understand that athletes competing in athletic and recreational sports programs risk injury to the body, psyche or property damage to themselves and others. Such injuries can be caused by teammates, other persons accidentally or intentionally self inflicted, faulty equipment or facilities, conditions of recreational facilities where sports activities are held, vehicle accidents while in transport or through the activity itself. In consideration for being permitted to participate with the New York Red Wings I release, waive, discharge and promise not to sue the New York Red Wings its volunteers and coaches and anyone else involved in running the New York Reds Wings (hereafter referred to as releasees) from all liability for any loss or damage, and any claim or demands therefore on account of serious or mortal injury to the body, injury to psyche or property of the minor child, or undersigned parent or guardian. I indemnify and hold harmless the releasees from any loss, liability, damage or cost it may incur due to the presence of the minor child, parent or guardian in, upon or about the premises of the training and playing facilities or equipment, or while participating in any sports activities whether caused by the negligence of releasees or otherwise. That the parent or guardian has read this Agreement, voluntarily signs the Agreement and that no oral representations, statements or inducements apart from the contents of this written Agreement have been made. I have read this Agreement and understand everything written above.
Your answer
Emergency Medical Consent and Electronic Signature
TYPING YOUR NAME IN THE BELOW BOX SERVES AS YOUR ELECTRONIC SIGNATURE TO THE FOLLOWING EMERGENCY MEDICAL CONSENT. I, the undersigned Parent/Guardian of the below named minor child participating in the sport of basketball with the New York Red Wings, hereby authorize an officer, coach or agent of the New York Red Wings to transport, as required, the below mentioned athlete for any medical attention. I hereby give my consent for said athlete to receive any and all medical care necessary to be administrated as prescribed by a duly licensed doctor under whatever conditions are necessary to preserve the life, limb, or well being of said athlete.
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A copy of your responses will be emailed to the address you provided.
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