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Name

Address

City

Birthdate

School & Grade

e-mail

*Parent/Guardian Waiver Signature

address

TEAM NAME:

Asst. Coach Name:

Head Coach Name:

Address:

Address:

City, State, Zip

City, State, Zip:

Phone:

Phone:

Cell:

Cell:

Email:

Email:

Bench Personnel:                   (1 only)

*I/we do hereby acknowledge, recognize and accept the inherent risk of bodily injury, disability, paralysis, and/or death to myself/ourselves and my/or my/our children that exists as a result of

my/our participation in any athletic endeavor, and specifically, by my/our participation in athletic endeavors offered or hosted by The CAGE.  As such, I/we do hereby agree to save, hold

harmless, and indemnify The CAGE, its owners, employees, agents, and other individuals or entities operating on behalf of The CAGE, for any bodily injury, disability, paralysis, and/or death, that

I/we and/or my/our children may sustain as a result of my/our participation in any athletic endeavor offered by The CAGE.

In the event that I/we or my/our children suffer some type of injury or illness which requires immediate medical treatment, I/we do hereby consent to and authorize the administration of such

first aid and/or medical treatment to myself/ourselves and or my/our children by employees and/or agents of The CAGE trained to administer such first aid and/or medical treatment.  I/we do

further consent to and authorize employees and/or agents of The CAGE to arrange for ambulance transportation for an appropriate medical facility for me/us and/or children.