Newport Sports Academy

Waiver

Download Waiver

Newport Sports Academy

Waiver

Applicant Information

Player’s name:Last

First

M.I.

Date:

Address:Street Address

Apartment/Unit #

City

State

ZIP Code

Player/ Parent Cell:

DOB:

Age:

Height:

Grade:

Male:

Female:

Parent 1 Full Name:

Relationship:

Email:

Phone:

Address:

Parent 2 Name:

Relationship:

Email:

Phone:

Address:

Emergency Contact:

Relationship:

Email:

Phone:

Address:

Health issues/ Allergies:

School Name:School

Disclaimer and Signature

My child (named above) has my permission to participate in NSA (“Newport Sports Academy”). By allowing my child to participate with NSA, I understand that there are associated costs that I will be responsible to pay. Sign-up fees are due at the time of sign-up, and uniform cost must be paid before the uniform is ordered. Waiver and Release: I hereby indemnify, defend, and hold harmless NSA and its owners, officers, agents, volunteers, and employees (“Organization”) from any and all claims arising out of injury, accidents, or illness to my child (named above) while participating in any clinics, tryouts, training, practices, tournaments, organization events and activities (“Organization Activities”). I authorize the Organization to act for me according to their best judgment in any emergency or other situations related to the activities requiring medical attention or discipline. My signature below constitutes consent to the applicability of the two preceding paragraphs for the duration of my child’s participation with NSA.

Signature:

Date: