Name of Athlete/Nombre de Atleta #1

First Name

Last Name

Date Of Birth/Fecha de Nacimiento

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DD

YYYY

Name of Athlete/Nombre de Atleta #2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Name of Athlete/Nombre de Atleta #3

First Name

Last Name

Date of Birth

MM

DD

YYYY

Name of Parent #1/Nombre de Padre/Madre

First Name

Last Name

Parent #1 Phone Number *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Parent #2

First Name

Last Name

Parent #2 Phone Number

(###)

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

(###)

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COVID-19 Waiver *

I read, reviewed, and agreed with COVID Waiver. Yo lei, entendi y doy mi autorizacion de las poliza de COVID.

Check Box

Social Media Release *

I read, reviewed, and agreed with COVID Waiver. Yo lei, entendi y doy mi autorizacion de las poliza de COVID.

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LYA/LYRC Polices & Procedures *

I read, reviewed, and agreed with COVID Waiver. Yo lei, entendi y doy mi autorizacion de las poliza de COVID.

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