High School Boys Basketball Registration Form 2024-2025 Athlete Participant InformationPlayer Name* First Last Grade for 24-25 School Year*Please enter the grade level for your student starting in the Fall 2024NinthTenthEleventhTwelfthHousehold / Adult Primary ContactRelationship to Participant* Parent Guardian Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Phone Type*HomeCellWorkEmail* Medical Information & WaiverPERMISSION & WAIVER OF LIABILITY & AUTHORIZATION FOR EMERGENCY CARE*I hereby give my consent for the above named student(s) to participate in the above specified sports program at The Denver Waldorf School. I also agree to reimburse The Denver Waldorf School for equipment issued to my child should it become lost. I understand The Denver Waldorf School cannot accept responsibility for personal items lost or stolen. I authorize the Athletic Director, Coach, or Sponsor in attendance at any DWS sports activity to select and secure medical attention as may be necessary for my child as a result of injuries or other events requiring emergency care while I am not in attendance at such event. I hereby release School of and from any and all liability, damages, costs, claims, demands, actions or causes of actions which it would otherwise incur arising from acts or omissions, other than grossly negligent or willful or wanton acts or omissions, of its teachers, agents or employees before, during or after any School activities or functions that may cause illness, injury or death to the student from any cause. **By signing, we agree to follow all communicated policies and procedures, including posted signs, related to COVID-19.** I have read and understand the above information.Secondary Emergency Contact Information* First Name Last Name Phone 1*Phone 2Secondary Emergency Contact Email* Sport SelectionHS Boys BasketballHigh School Boys Basketball* HS Boys Basketball Volunteer* Volunteer fee Volunteer hours Coupon Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name ACHI understand that I will be notified if a sport I have registered & paid in full for is cancelled due to lack of enrollment. I understand I will receive a full refund for a cancellation by The Denver Waldorf School.* YesBy choosing "yes" and submitting this form, you understand that this constitutes a legally-binding signature.* Yes
