Girls Flag Football Camp - Fall 2022

* Required Fields
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Participant Information
*First Name
Middle Initial
*Last Name
Gender
Male  -- unavailable
 Female 
*Date of Birth
mm/dd/yyyy
*Grade
*Age
*Street Address
*City
*State
*Zip Code
*School
*Shirt Size
*Pant Size
Participant Medical Information
*Height
*Weight
*Medical Conditions/Allergies
Special Needs/Requests
Physician Name
*Emergency Contact Name
*Emergency Contact Relationship
*Emergency Contact Phone(s)
Physician Phone
*Medical Insurance Carrier
*Insurance Policy #
Parent / Guardian 1 Information
*Guardian 1 Name
*Relationship
*Street Address
*City
*State
*Zip Code
*Guardian 1 Email
*Daytime Phone
Evening Phone
Mobile Phone
Date of Birth
mm/dd/yyyy
Volunteer - Coach
  
Volunteer - Assistant Coach
  
Volunteer - Fundraising
  
Volunteer - Field Maintenance
  
Volunteer - Team Parent
  
Volunteer - Event Support
  
Coaching Experience
Parent / Guardian 2 Information
Guardian 2 Name
Street Address
City
State
Don't type in this field
Zip Code
Guardian 2 Email
Daytime Phone
Evening Phone
Mobile Phone
Relationship
Date of Birth
mm/dd/yyyy
Volunteer - Coach
  
Volunteer - Assistant Coach
  
Volunteer - Fundraising
  
Volunteer - Field Maintenance
  
Volunteer - Team Parent
  
Volunteer - Event Support
  
Coaching Experience
Waiver
Waiver
1.    Waiver and Release:  I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a flag football event and related sports conditioning activities.  I further agree on behalf of myself, my heirs, and my personal representatives, that Bridgeport Youth Lacrosse Inc, along with the coaches, shall not be liable for any injury, loss of life, or other loss of damage occurring because of my child's participation in the event.

2.    Medical Attention:  I hereby give my consent to Bridgeport Youth Lacrosse Inc to provide, through a medical staff of its choice, customary medical / athletic training attention, transportation, and emergency medical services as warranted during my participation in Bridgeport Youth Lacrosse Inc sponsored or sanctioned events. 

3. Readiness to Compete:  I will only participate in those competitions or activities in which I believe I am physically and psychologically prepared to participate.
                                                                                               
As legal guardian of this participant, I hereby verify by checking off below that I have read and fully understand each of the conditions under of the Participant Waiver & Release section for permitting my child to participate in any Bridgeport Youth Lacrosse Inc sponsored events and activities, and I accept each of the conditions, especially the waiver and release set forth in paragraph one. 
*Waiver confirmation
 I have read and agree with the waiver. 
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