| Participant's First Name: | |
| Participant's Last Name: | |
| Parent/Guardian First Name: | |
| Parent/Guardian Last Name: | |
| Street Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Home Phone: | |
| Email Address: | |
| Father's Cell Phone: | |
| Mother's Cell Phone: | |
| Parent's Place Of Employment: | |
In the event that there is a coach needed
to help coach your child's team,
would you be interested?: | Yes No |
| Are you a member of a church? | Yes No |
| If yes, where? | |
| Age: | |
| Birthdate: |
(Day) (Year - ex: 2001) |
| Grade: | |
| School: | |
| Gender: | Male Female |
| Coach Request: | |
| Team Player Request: | |
| Please indicate which league you would like your child to play (a child can play in a league that is older than his/her age, but not younger). | |
| Uniform Size: | |
Person (other than parent) authorized
to act for parent in an emergency: | |
| Emergency Contact Home Phone: | |
| Emergency Contact Work Phone: | |
Release of All Claims |
In consideration for my child being allowed to participate in activities sponsored by Calvary Baptist Church, I hereby release, discharge, indemnify, and agree to hold harmless Calvary Baptist Church, its directors, officers, employees, agents, and all volunteer personnel from any and all liability for personal injuries and/or damage(s), injury or illness that may be suffered by the above participant.
I / we further agree to indemnify and hold harmless Calvary Baptist Church, its directors, officers, employees, agents, and all volunteer personnel from any claim and/or damages it, or its agents are required to pay as a result of any injury or damage including reasonable attorney fees, litigation expenses, and court costs. |
| Yes, I understand and agree to the Release of All Claims as set forth above. |
|