CMCC Registration Form

* = Required Field

Player's / Cheerleader's Name *

First NameLast Name

Home Phone*

Area CodePhone Number

Father's Name*

First NameLast Name

Father's Work Phone*

Area CodePhone Number

Father's Cell Phone*

Area CodePhone Number

Father's E-mail*

Mother's Name

First NameLast Name

Mother's Work Phone*

Area CodePhone Number

Mother's Cell Phone*

Area CodePhone Number

Mother's E-mail*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact*

Emergency Contact Phone*

Area CodePhone Number

Family Physician*

Family Physician Phone*

Area CodePhone Number

List all known pre-existing conditions, prior injuries or congenital problems:

List all known allergies:

Medication(s) currently taken:

I give my consent for emergency medical attention to be administered to my son/daughter prior to my being contacted or my arrival.

Parent/Guardian Signature*

Date*

MonthDayYear

Note: Parents will be notified in case of a serious injury or illness as quickly as they can be reached, but this form will make immediate treatment possible.

WAIVER (must digitally sign below)

WAIVER (must digitally sign below) Release And Waiver of Liability, Assumption of Risk, and Indemnity Agreement ("Agreement")

In consideration of participating with Central Maryland Christian Crusaders I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity.

I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releasees" named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my participation in the Activity.

I hereby release, discharge, and covenant not to sue the Central Maryland Christian Crusaders, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "releases" or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the releases, I will indemnify, save, and hold harmless each of the releases from any loss, liability, damage, or cost which any may incur as the result of such claim.

I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

PARENTAL CONSENT

AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasers from any litigation expenses, attorney fees, loss liability, damage, or cost any Release may incur as the result of any such claim.

Terms Agreement*

Yes I agree to the terms above

Digital Signature*

Digital Signature Date*

MonthDayYear

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