Fall Micro Soccer Registration | St. Bernard Catholic Community

Name *

First

Last

Child's Grade *

Child's Gender *

Female
Male

Child's Birthday mm/dd/yyyy *

School Child Attends *

Pick Child's Sport *

Micro Soccer $25

Shirt Size *

Dad's Name *

Mom's Name *

Are you member(s) of St. Bernard Parish?

Yes
No

Parent's Cell - Dad *

Parent's Cell - Mom *

Parent's Email - Dad *

Parent's Email - Mom *

Mother's Month/Day of Birth (Year NOT required)

Address *

Address Line 1

City

State

Zip Code

Mom or Dad is interested in coaching? *

Yes
No

Mom or Dad is interested in assisting the coach? *

Yes
No

Waiver and Release for Participation in Activities at St Bernards School *
"In consideration for being allowed to participate in this Activity, I release from liability and waive my right to sue St Bernard School, their employees, officers, volunteers and agents from any and all claims, including claims of the school's negligence, resulting in any physical injury, illness (including death) or economic loss I may suffer or which may result from my participation in this Activity, travel to and from the Activity (including air travel), or any events incidental to this Activity".

"I am voluntarily participating in this Activity. I understand that there are risks associated with my participation in this Activity, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, death or economic loss. These injuries or outcomes may arise from my own or other's actions, inactions, or negligence, or the condition of the Activity location (s) or facility (ies). Nonetheless, I assume all risks of my participation in this Activity, whether known or unknown to me, including travel to and from the Activity (including air travel) or any events incidental to this Activity."

I agree to hold St Bernard School harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney's fees, as a result of my participation in this Activity, including travel to and from the Activity (including air travel) or any events incidental to this Activity.

Medical Release "If I need medical treatment as a result of my participation in this Activity, travel to and from the Activity (including air travel), or any events incidental to this Activity, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware that St Bernards School does not provide health insurance for me and that I should carry my own health insurance."

"I am the parent or legal guardian of the Participant. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing St Bernard School from all liability on my and the Participant's behalf, (b) waiving my and the Participants' right to sue St Bernards School, (c) and assuming all risks of Participant's participation in this Activity, including travel to and from the Activity (including air travel) or any events incidental to this Activity. I allow the Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of the Participant as described in this document. I agree to be bound by the terms of this document." Signature Required Below

Signature *

Signature Required as Waiver and Release for Participation in Activities at St Bernards School