PSA Event Registration

Player Information:

First Name:
Last Name:
Date of Birth:
Age:
School:
Grade:
Gender:MaleFemale
Shirts Sizes:
Youth:XLLMS
Adult: XLLMS
Shorts/Pants Sizes:
Youth:XLLMS
Adult: XLLMS

Parent/Legal Guardian Information:

First Name:
Last Name:
Address:
City:
Zip Code:
Home Number:
Mobile:
Work Phone:
Email:
Interested in Coaching? YesNo
If yes, what age group?:
Interested in joining a committee?FundraisingRegistration/EnrollmentTeam RefreshmentsTravel ArrangementsGeneral Assistance
I, the Parent(s) or legal Guardian of the named participant(s) for a position on a Peninsula Sports Academy team, give consent to his/her participation in any and all team activities during the current season. I assume all risks and hazards incidental to such participation, including transportation to and from activities. I hereby waive, release, absolve, indemnify, and agree to hold harmless the league, organizers, sponsors, supervisors, participants and persons transporting my child to or from activities, for any claim arising from an injury to my child.

MEDICAL RELEASE

In case of an emergency and my family Physician cannot be reached; I hereby authorize the PSA to have my child treated by another qualified, licensed physician who is avallable.
Physician/Hospital:
Phone:
Address:
Date of last Physical:
Allergies:
Medication:

PICTURE RELEASE

I,
give permission for the Paxton Sports Academy to publish photos of my child,
, on the official PSA website or local newspaper. First names only wil be used.
I have read and understand the above and have completed this form to the best of my ability. I also support PSA's philosophy, which is based on participation, fun, fitness and health, skill development, teamwork, fair play and leadership.
Parent signatur:
Date:

PSA Use Only:

Returning PlayerNew Player
Check:#
Cash:$
Payments #1:$
Payments #2:$
Payments #3:$
Birth Certificate CopyAAU Release Form
Other: