Participant's Birth Date
-
Month
-
Day
Year
Date
Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Full Name
*
First Name
Last Name
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.
Agree
Cell Phone Number
Home Phone Number
E-mail
example@example.com
Relationship
Emergency Contact#2 Name
*
First Name
Last Name
Emergency Contact#1 Name
*
First Name
Last Name
Cell Phone Number
Home Phone Number
Relationship
E-mail
example@example.com
Dad's Cell Phone Number
Mom's Cell Phone Number
Home Phone Number
Dad's E-mail
example@example.com
Mom's E-mail
example@example.com
Parent/ Guardian Full Name
*
First Name
Last Name
Tshirt Size
Please Select
XS
S
M
L
XL
Participant's blood type
Child's Allergies or medical problems
Grade Completed
Please Select
4
5
6
7
8
Team Lead
Email
example@example.com
Parish/School
Participant's Full Name
*
First Name
Last Name
Submit
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Should be Empty: