CARWATHA FOOTBALL COLLEGE
CLINIC REGISTRATION FORM
Kindergarten / School you currently attending?
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Student Name
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First Name
Last Name
D.O.B
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Month
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Day
Year
Date Picker Icon
Parent/ Guardian Name:
First Name
Last Name
E-mail
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Phone Number
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MEDICAL INFORMATION
Please provide any current or previous medical conditions we should be aware of so we can support your child.
Any Medical Conditions?
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Yes
No
If answered yes please identify medical conditions
Emergency Contact Person
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First Name
Last Name
Emergency Contact Number
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PROGRAM INFORMATION
WOULD YOU LIKE TO FIND OUT MORE ABOUT THE CARWATHA FOOTBALL COLLEGE OR SCHOOL?
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YES
NO
SPORTS RISK WAIVER
Type a question
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I acknowledge that there are inherent risks involved in my child participating in the Carwatha College Football Program. I discharge all directors, employees, coaches and guest coaches/ players from any and all liability for injury, loss or damage caused arising out of my participation in the program. I agree that I will not sue including all directors, employees, coaches & guest coaches/ players in the future, for any kind of injury, damage or loss that occurs while participating in the program. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
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