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dawn patrol Registration Form

Please send checks and registration forms to: 38 Marvin Lane Commack, NY 11725

________________________________________________________________________ Parent’s Signature Date


dawn patrol Registration Form

________________________________________________________________________ Players Name Parents Name ________________________________________________________________________ Home Phone Cell Phone ________________________________________________________________________ Address ________________________________________________________________________ Town State Zip ________________________________________________________________________ Email Address ________________________________________________________________________ Emergency Contact Emergency Phone ________________________________________________________________________ Date of Birth Grade Entering Fall 2014 ____ Summer Kick Off Clinic: $15 April 16th Session I 2pm – 4pm All

____Summer Kick Off Clinic: $15 April 16th Session II 2pm -4pm All

____Camp: $285 before 5/15 $315 after 5/15 July 14-18th 8:30am – 2:00pm Juniors

____Club: $600 May 20th – August 9th 5:30pm Tues/Thurs Juniors

____Clinic 1: $100 June 4, 11, 18, 25 - 6:00pm Junior/Adult

____Clinic 2: $100 July 2, 9, 23, 30 - 6:00 pm Junior/Adult

Liability Waiver, Assumption of Risk and Release I understand that there are certain inherent dangers in participating in sports activities that may include permanent disability and death. I have inspected the facilities and equipment prior to participating in any activities to ensure that they are safe. I do hereby waive, release, and forever discharge the club and its officers, agents, employees, representatives, executors and all others from any and all responsibilities or liability from injuries or damages resulting from my child's participation in any dawn patrol activities. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to my child, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my child's participation in any activities of the club or the use of any equipment at the club. I declare my child to be physically sound and suffering from no conditions, impairment, disease, infirmity, or other illness that would prevent my child's participation in sports activities. In case of accident or injury and an emergency contact person cannot be reached, I grant dawn patrol permission to obtain medical attention for my child if necessary, for which I will be financially responsible.

________________________________________________________________________ Parent’s Signature Date


dawn patrol Registration Form I understand that dawn patrol retains the rights to any photographs or video taken at the facility to be used for publicity or advertising.

________________________________________________________________________ Parent’s Signature Date


Registration form 3