Player’s Name____________________________________ Date of Birth__________
Father and Mother’s Name ________________________________________________
Street Address___________________________________________________________
City _________________________ Zip_____________ Phone ___________________
Cell _________________ Email____________________________________________
School ______________________________Current grade as of season ____________
Birth Certificate
Participant’s Legal Address Is In PARKLAND SCHOOL DISTRICT- YES NO
I understand as parent and/or natural guardian of ______________________ that they are signing up for a supervised sport. While participating in this activity, I understand that my child will be doing supervised activities some of which have the potential to cause injuries. I acknowledge the fact that North Parkland is very dedicated to safety and will do all they can to protect my child from a dangerous situation, however, by signing this form I further acknowledge that as with any sporting event, my child runs the risk of being injured. My signature on this form hereby releases NPAA, as well as board members, coaches and volunteers, from any liability for bodily injury for medical claims my child may sustain while attending activities at North Parkland. My signature also releases Parkland School District and their employee employee’s and volunteers from any claim of liability for bodily injury while my child is attending and activity for NPAA. Further, my signature acknowledges that I hold harmless NPAA, their board members, coaches and volunteers from presenting any medical or bodily injury claims in the event of an injury to my child.
Signature _________________________________________ DATE ______________
Registration Fee: $70 (Buy-out-$100)
Paid: cash check # ___________ Amount $_________________
If paying by check please include your Driver’s license number and expiration date.
Driver’s License # _______________________ Exp. Date____________________
Fundraising Buy-out _______ Basket _______________________________________
If registering multiple children please list their names, birth date, and grade level.
NAME Birth date Grade level
1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________
