sports registration

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Primary Phone *

(###)

###

####

Emergency Contact's Phone *

(###)

###

####

Media *

By checking "Yes, I agree," I give permission to Empowered Fitness LLC (dba Play Sports) to feature photos or videos via the Brightwheel app that may include my child. I understand the featured media will not have first and last names listed and only available to families of classmates. I give permission for my child's face to be included in classroom pictures sent through the approved app to other parents.

Yes, I accept.

Liability *

By checking "Yes, I agree," I waive any and all claims for my child against Empowered Fitness LLC (dba Play Sports), its coaches, and the school and staff, for any illness or injury which may result directly or indirectly from participation in this activity.

Yes, I agree.