Sports Activity Disclaimer Acknowledgement
Please complete this form to acknowledge and accept the risks associated with participating in the sports activity.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select the Sports Activity
*
Please Select
Soccer
Basketball
Swimming
Tennis
Running
Other
Date of Activity
*
-
Month
-
Day
Year
Date
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or allergies we should be aware of?
Relationship of Emergency Contact to Participant
*
Please Select
Parent/Guardian
Spouse/Partner
Sibling
Friend
Other
If participant is under 18, please provide Parent/Guardian Name
First Name
Last Name
Signature
*
Acknowledge and Submit
Acknowledge and Submit
Should be Empty: