Player Name
*
First Name
Last Name
Player Age
*
Player Birth Date
*
MM
DD
YYYY
Parent Name
*
First Name
Last Name
Parent Phone Number
*
(###)
###
####
Parent Email
*
Parent #2 Name (optional)
First Name
Last Name
Parent #2 Phone Number (optional)
Optional
(###)
###
####
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Insurance Carrier - Company Name
Insurance Carrier - Company Phone
(###)
###
####
Please share any pertinent medical history, conditions, or considerations here:
Preferred Hospital
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 2025 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.
Thank you for registering for TUSC365 + AMS After School Programming! Do you have any questions, concerns or suggestions for the TUSC365 staff?