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5 Star Athletics yearly waiver and release of liability form

I certify that my child has no injuries or illnesses that would limit their participation in any 5 Star Athletics LLC program. I authorize 5 Star Athletics LLC staff to act for my child according to their best judgement in any emergency requiring medical attention. I hereby waive and release 5 Star Athletics LLC from any and all liability for any injury or illness incurred while participating in any practice. My child has medical coverage and I will be responsible for any expenses resulting from injury, illness, or accident incurred during any practice. I will grant authority to the first aid and CPR certified trainer on site to provide necessary and reasonable medical attention to my child. I further authorize the use of photos of my athlete taken while playing or practicing to be used on the 5 Star Athletic's website, in publicity materials or in other program material. I understand that this form is good for the calendar year stated above for any 5 Star Athletics Program. I understand that it is my reponsibility to update this form if changes occur.

First Athlete's Name

First Name*

Last Name*

Phone*
First Athlete's Date of Birth*
First Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
First Athlete's Signature*
Second Athlete's Name

First Name*

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Third Athlete's Name

First Name*

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Fourth Athlete's Name

First Name*

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Fifth Athlete's Name

First Name*

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Sixth Athlete's Name

First Name*

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Seventh Athlete's Name

First Name*

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Eighth Athlete's Name

First Name*

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Ninth Athlete's Name

First Name*

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Tenth Athlete's Name

First Name*

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Athlete's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Join our mailing list!!
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Known Allergies/Health Issues/Medications

Any known?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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