Player Name
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Parent #2 Name
(optional)
First Name
Last Name
Parent Email
*
Parent Phone #1
*
(###)
###
####
Parent Phone #2
(optional)
(###)
###
####
Player Date of Birth
*
MM
DD
YYYY
Player Grade (Fall 2024)
*
Player School (Fall 2024)
*
Player Jersey Size
*
Youth SM
Youth M
Youth L
Adult Small
Adult Medium
Adult Large
Adult X-Large
Ultimate Experience
*
Briefly describe player's experience playing Ultimate
Registration Type
*
Individual Tournament Registration
Buddy / Pair Tournament Registration
Small Pod Tournament Registration
Team Tournament Registration
Elementary Pick-up Game/Clinic Registration
TEAM/POD REGISTRATIONS ONLY: What is the UNIQUE NAME of your team/pod?
(OPTIONAL. This question only applies to team and pod registration types. If you're not entirely sure about your team/pod name, just make your best guess and we'll figure it out!)
TEAM/POD REGISTRATIONS ONLY: Who is your team/pod LEADER OR CAPTAIN? (You may name multiple people if you have more than one!)
(OPTIONAL. This question only applies to team and pod registration types. If you aren't sure about your team leader or captain, just make your best guess!)
TEAM/POD REGISTRATIONS ONLY: If your team/pod is bringing your own coach, what is that coach's name?
(OPTIONAL. This question only applies to team and pod registration types. If you aren't sure about your coaching situation, just make your best guess!)
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Emergency Contact Relationship to Player
*
Insurance Carrier Name
*
Insurance Carrier Phone
*
(###)
###
####
Preferred Hospital
*
Medical Concerns / Considerations
How did you hear about our TUSC365 Fall Tournament?
*
Liability Waiver
*
This acknowledges that we, the undersigned, parent(s) or legal guardian(s), recognize the potentially hazardous nature of the sport of Ultimate that an injury may be sustained. These injuries include, but are not limited to, PERMANENT DISABILITY, BLINDNESS, PARALYSIS and DEATH. In the event of such injury to the participant and we (I or my spouse or guardian) cannot be contacted, we give permission to qualified and licensed EMTs, physicians, paramedics, and/or other medical or hospital personnel to render appropriate treatment.
We (I) release the 2024 Texas Ultimate Summer Camp, its employees, its agents, its volunteers and its assigns from any personal injuries caused by or having any relation to this activity. We (I) understand that this release applies to any present or future injuries or illnesses and that it binds my heirs, executors and administrators.
I hereby authorize the Texas Ultimate Summer Camp to photograph and record my child’s likeness and participation for use in the above programming or parts thereof, including publication on the internet, published documents, and any other advertisements or promotional materials.
This release form is complete and signed of my own free will and with full knowledge of its significances. I have read and understand all of its terms.
Do you have any questions or requests for Coach Kepner and the TUSC365 Fall Tournament staff?
We'd love to address any ideas in our plans for the 2024 TUSC365 Fall Tournament!