Annandale Sports Clubs Registration Form
First Name

Last Name

DOB

Gender
Address
Street 1
Street 2

City

State

Zip Code

County/City of Residence

E-Mail

Alt. E-Mail

Home Phone

Office Phone

Cell Phone


School

Grade as of 10/1/2010

Parent or Guardian #1

Name

Address

City                                       State               Zip Code

Home Telephone Number

Work Telephone Number

Cell Number

E-Mail Address

Relationship


Parent or Guardian #2

Name

Address

City                                       State               Zip Code

Home Telephone Number

Work Telephone Number

Cell Number

E-Mail Address

Relationship


Emergency Contact Information

Emergency Contact

Phone Number

Insurance Company

List any Medical Problems or N/A





Volunteers Needed

Volunteer
IMPORTANT POLICY INFORMATION:

*Read the following information and check the box to indicate your agreement.

As parent/guardian, I understand that there is a risk of injury to my child as the result of participation in Annandale Sports Club activities. In the event of such injury, this authorizes the Annandale Sports Club team representative to obtain the necessary medical or hospital treatment for my child. I, both on my behalf and on behalf of my child, assume all risks of loss and risk of injury to my child as a result of his/her participation in any  Annandale Sports Club activities. I further agree to hold Annandale Sports Club and its administrators, board members, coaches, representatives and other volunteers harmless from any and all claims, including personal injury, and any related expenses (including reasonable attorneys fees), arising out of or in any way connected with my child's participation in any Annandale Sports Club activity.


Annandale Sports Club wants to ensure that all equipment used by our players is safe and in some cases certified. If a parent chooses to purchase their own equipment (in lieu of or in addition to Annandale Sports Club provided equipment), you must meet the sports' designated safety certification. If not, the participant can be deemed ineligible to participate in practice and/or games. Please see your Commissioner or League Director for details before purchasing any equipment.