DIVISION *

U11 Girls (2014 or later)

U12 Girls (2013 or later)

U13 Girls (2012 or later)

U14 Girls (2011 or later)

Junior Girls (2009 or later)

Senior Girls (2006 or later)

Women’s Division (19+)

TEAM CONTACT NAME *

First Name

Last Name

TEAM CONTACT PHONE NUMBER *

(###)

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WHAT LEVEL IS THE TEAM? *

A

A/AA

AA

AA/AAA

AAA (Strongest)

FULL NAME *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

PLAYER CONTACT NUMBER *

(###)

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FULL NAME *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

PLAYER CONTACT NUMBER *

(###)

###

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FULL NAME *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

PLAYER CONTACT NUMBER *

(###)

###

####

FULL NAME

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

PLAYER CONTACT NUMBER

(###)

###

####

FULL NAME

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

PLAYER CONTACT NUMBER

(###)

###

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INFORMED CONSENT AGREEMENT *

I/We the UNDERSIGNED hereby acknowledge that RISKS OF INJURY are inherent to participation in sports and recreation activities. These types of injuries may be minor or serious and may result from one’s actions, or the actions or inactions of others, or a combination of both. I/We understand that the RULES and REGULATIONS are designed for the safety and protection of the participants and hereby undertake to abide by these rules and regulations. I/We hereby WARRANT being physically fit to participate and understand the CHOICE to participate brings with it the ASSUMPTION OF THOSE RISKS AND RESULTS which are part of these activities. I/We agree that LEAD THRU SPORT shall not be liable for any injury to my/my child’s person and loss or damage to my child’s personal property arising from, or in any way resulting from, my/my child’s participation in these activities. UNLESS such injury, loss or damage is caused by the SOLE NEGLIGENCE of the School or its employees are agents while acting within the scope of their duties. I/We declare having read and understood the above INFORMED CONSENT AGREEMENT in its entirety and hereby consent to participate acknowledging all the foregoing. Permission is also given for use of any photos or videos taken of myself/my child to appear in any promotional materials or advertisements produced by Lead Thru Sport.

I have read, understand & agree to the Informed Consent Agreement above.

MEDIA RELEASE *

I/We give permission for use of any photos or videos taken of myself/my child to appear in any media, promotional materials or advertisements produced by Lead Thru Sport.

I have read, understand & agree to the Media Release above.