Child's Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

Male

Female

Parent Name *

First Name

Last Name

Phone Number *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Would you be interested in Volunteering? *

Yes

No

do hereby grant permission for my son/daughter, named on this form, to attend the Calgary Croatia Sports Club Youth Development Day. I fully understand that there is always a possibility that my child may sustain physical illness or injury while playing sports. I acknowledge and understand that my child is assuming the risk of such physical illness or injury by his/her participation, and I further release the sponsoring organizations (Calgary Croatia Sports Club) and its representatives from any claims for personal illness or injury that my child may sustain during the program. I further acknowledge and understand that my child will be responsible for his/her failure to abide by the rules and regulations of the program. If an injury occurs, I understand that the program coordinators will attempt to contact me at the emergency numbers I have provided on this form. If I am unreachable, I hereby authorize the program coordinators and representatives to act on my behalf should an injury occur. In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness during the Calgary Croatia Sports Club Youth Development Day, I hereby authorize the program coordinators to obtain or provide medical treatment for my child for such injury or illness during the program, and I hereby hold the program coordinators and sponsoring organizations, as well as its representatives, harmless in the exercise of this authority. *

Agree

Disagree