ATHLETES/PARENT REGISTRATION Page 2

We need some information about you, the Parent/Guardian. Even if you are registering a child, we need your information first. You have the option to add a second Parent/Guardian. You will enter your child’s information on the next screen.

Parent Details

Player Details

Disclosures

Programs

Player Details

Player First Name:

Player Last Name:

Date of Birth:

Age

Sign-Up Date

Verifiction of Specil Needs

Yes

Name of Player's School District

I hereby consent to Beach Cities Miracle League to take or have taken by others, photographs, digital images and/or audio and/or video footage (the images) of the student named below, and to store the images, make copies of the images and publish the images in any form, in whole or in part, and distribute them in any medium including, but not limited to, print media, the Internet, CD-ROM, other multi-media uses or graphic representation, cinematography or video

Yes

* FIELDS REQUIRED

RESOURCES FOR:

TM

Player Details

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