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CSC Registration

COHASSET SPORTS COMPLEX

Cohasset Sports Complex is taking measures to reduce the risk of the spread of the COVID-19 virus, in compliance with federal, state and local guidelines. We respectfully request that all of our patrons and guests take similar measures to avoid exposing other patrons and guests to the spread of the COVID-19 virus, including by wearing a mask as appropriate, limiting physical contact with others, and minimizing the time you spend inside our facilities as much as possible. If you have the COVID-19 virus or you have any symptoms of the COVID-19 virus, we respectfully request that you do not enter our facilities or the surrounding premises at this time. By entering our facilities and/or the surrounding premises, you acknowledge and understand that, despite our efforts to reduce the spread of the COVID-19 virus, you and those for whom you are a guardian have the potential to be exposed to others with the virus and/or to contract the virus as a result of your participation in activities on our premises, including merely entering our facilities where other persons have visited. To that end, you agree and understand that there are dangers inherent to being in a public setting caused by the COVID-19 pandemic, and you expressly understand that your participation in such activities, and even your presence in our facilities, may expose you to the risk of acquiring the COVID-19 virus. By entering our premises, you and those for whom you are a guardian hereby assume the risk of any exposure to the COVID-19 virus in our facilities and our surrounding premises, including but not limited to the risk of illness and death that has been associated with the COVID-19 virus, and you agree to waive and hold us harmless for any claims of injury, illness or death stemming from the COVID-19 pandemic.

Parent/Guardian Signature:

* Summer Camp participants MUST provide a copy of their most recent physical exam and immunizations!*


CSC Registration
RELEASE OF LIABILITY AND WAIVER FORM

As the parent/legal guardian of the minor(s), I request that in my absence the above named player be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures, and x-ray treatment to the above minor. I have not been given any guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named player.

Date signed: May 28, 2022

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
First Participant's Signature*
Second Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Third Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Fourth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Fifth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Sixth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Seventh Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Eighth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Ninth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Tenth Participant's Name

First Name*

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

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant'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/Guardian Information

Home Phone: (______) _________________

Cell Phone: (______) _________________ *

Work Phone: (______) _________________
Emergency Contact Information

Person to notify if parent/guardian is unavailable: *

Address: *

Home Phone: (______) _________________

Cell Phone: (______) _________________ *

Work Phone: (______) _________________

Emergency Contact Relationship: *
Insurance

Insurance Carrier*

Insurance Policy Number*
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*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age *

Grade (in Sept.): *

Caregivers’ names: *

Date of Tetanus Booster: (listed as DTAP or TdaP on physical)

Known Allergies of this player, including allergies to medicine:

Any other medical problems that should be noted:
  
Upload Physical
Valid file types: JPG, GIF, PNG, and PDF
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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