WBSA Spring Season 2021
Player Name: __________________________________ Team Name: _____________________
Home#: __________________________ Cell#: _____________________ DOB: ___________
Emergency Contact Person: _____________________ Phone#: _______________________________
E-Mail: _______________________________ circle sport: Soccer t-ball
I hereby give my full consent and approval for participating as a team member in the sport or activity designated above.
I understand that there are certain risks of injury inherent in the practice and play of this sport or activity, as well as in traveling and other related activities incidental to my participation, and I am willing to assume these risks. I hereby certify that I’m fully capable of participating in the designated sport or activity and that I am healthy and have no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed below.
In addition of giving my full consent for my kid participation, I do hereby waive, release and hold harmless WBSA and its officers, coaches, sponsors, supervisors and representatives for any injury that my kid may be suffered in the designated sport or activity and the activities incidental thereto, whether the result of negligence or any other cause.
Please list any physical limitations (allergies, hearing, sight, etc.)
(Parent if under 18 yrs. Of age)
Date: ___________________ WBSA 2021