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)
*
How many TUSC365 Fall League dates will you be attending?
*
All Three Dates
Single Day Registration
Two-Day Registration
Which specific dates will you be attending?
(This question applies to single and two-day registrations only.)
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
Has this player ever captained an ultimate team?
*
Yes
No
Friend(s) / Teammates (optional)
Are you signing up with a friend? (Note that they will need to put YOUR name down as well to ensure that you’re placed on the same team! Talk to them about this!)
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 TUSC365 Fall League?
*
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 2023 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 League staff?
We'd love to address any ideas in our plans for league!