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Registration
1
Parent Information
2
Disclaimer
3
Last Page
Parent #1 Information (Required)
First Name
*
Last Name
*
Home Phone Number
Cell Number
*
Email
*
Address
*
Apt/Unit #
City
*
Postal Code
*
Parent #2 Information
First Name
Last Name
Home Phone Number
Cell Number
Email
Address
Apt/Unit #
City
Postal Code
Indicate the number of players being registered.
*
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Player Information
First Name
*
Last Name
*
Date of Birth
Gender
Male
Female
Other
Athlete's Health Card Number
Athlete's Cell
Athlete's Email
IndustryHealth Information
Allergies
Asthma/Respiratory concerns
Blackouts/Fainting
Chest Pain
Diabetes
Epilepsy
Hearing Disorder
Heart Condition
Recurring Headaches
Seizures
Glasses
Contact Lenses
Injuries
Medications
Other
Check any medical ... that your child has
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Motion Ball Sports Association (MBSA) will not be held responsible for any injuries sustained by a player while playing at any facility or programs operated by the MBSA. I/We acknowledge that all intellectual property, rights and ownership of any media taken and any reproduction thereof, arising from any sports of interests, and/or activities will belong to the MBSA. I/We hereby release, discharge and agree to save harmless any MBSA parties from all liability arising in connection with the sport(s) of interest, and/or activity.
There is a cancellation fee of $75.00. No refund will be issued after the 2nd week of the program. A fee of $45.00 will be charged for all NSF Cheques.
This form must be signed by a parent/guardian if the player is under eighteen years of age.
I/We agree to abide by all rules and regulations of the Motion Ball Sports Association.
I agree
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