Registration Form - Blazers 2019 April Vacation Camp

Registration:
Please fill out all of the information below, using both upper and lower case as appropriate (i.e., please do not leave ALL CAPS on when you fill this out), and please use informal names (ex: Timmy not Timothy)

Question Title

* 1. Player Information:

First Name: *

Last Name: *

DOB (MM/DD/YYYY): *

Allergies or other Physical/Medical Concerns:

Medical Insurance: *

Policy #: *

Question Title

* 2. What grade is your player?

Question Title

* 3. Gender of Player:

Question Title

* 4. The Player is from what town?

Question Title

* 5. Parent1 Information

First Name: *

Last Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Cell Phone: *

Email Address: *

Question Title

* 6. Parent2 or Other Emergency Contact

First Name:

Last Name:

Cell Phone:

Email Address:

Question Title

* 7. TERMS AND CONDITIONS:

Waiver: As the parent or legal guardian of the participant named above, I hereby give my full consent and approval for my child to participate in this program. I understand that there are certain risks of injury inherent in the practice and play of this sport, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or developmental disabilities or infirmities that would restrict full participation in these activities, except as listed above. I understand that my medical insurance is expected to cover the cost of my child’s injuries. I grant permission to the coaches or volunteers involved with this program to seek medical care in the event I cannot be reached. I agree not to hold Alpha Youth Sports, Fay School, the Town of Southborough, or any of the parties/facilities connected with this program responsible for any injury or accident that may occur to my child (or anyone accompanying them) during the program, whether the result of negligence or any other cause.

Video Release: For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of my child and the recording of my child's voice by Alpha Youth Sports, Inc. (“AYS”) during this program. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage. Provided that AYS does not identify my child's last name, nor town of residence in these photographs or recordings, I irrevocably consent to the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes, as well as to the reproduction and/or authorization by AYS to reproduce and use said photographs and recordings of my child's voice, for use in all domestic and foreign markets. I hereby release AYS, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies or other assigned third parties, their directors, officers, agents and employees from all claims of every kind on account of such use.

Program Dismissal: I understand that the facilities used in this Program have established usage, behavior and other rules that apply to the participant and the parents, siblings, and others that accompany the participant. I understand that if my child, or anyone accompanying them to a practice, game, or other event violates a rule or becomes a discipline problem, he/she may be dismissed from the Program, and that no money will be refunded. I further understand that if my child is unwilling to fully participate in the program or is otherwise acting in a manner that, in AYS's sole discretion, is having a negative effect on the experience of the other participants in the program, that he/she will be dismissed from the program.

Do you acknowledge your understanding and acceptance of these Terms and Conditions?

Yes