EMH Sports and Fitness Institute

“Promoting Physical Education for Life”

   ATHLETIC PARTICIPATION FORM

 

NAME:_______________________________________________________________________

            Last                                  First                          MI                                

BIRTHDATE:__/__/__ School:___________________________________Grade:____________

ADDRESS: ___________________________________City_______________Zip____________

EMAIL ADDRESS:______________________________(For confirmation of PE activities only)

EMERGENCY PHONE: (must have)__________________ HOMEPHONE:________________

FATHER’S WORK PHONE_______________MOTHER’S WORK PHONE________________

 

PLEASE SIGN #1 OR #2 (Card will be voided if both are signed):

1.  Parent Signature: ___________________________________Date:_______________

I hereby GIVE my consent for my son/daughter (name)_____________ to be given medical aid, if necessary, during any EMH sponsored athletic team activity.  I authorize such care and treatment to be performed by a licensed Physician or Surgeon.  I FULLY UNDERSTAND THAT I WILL BE RESPONSIBLE FOR ALL COSTS INCURRED BY EMERGENCY TREATMENT SERVICES, INCLUDING AMBULANCE OR EMERGENCY TRANSPORTATION.  X____Initial

2.  Parent Signature:_____________________________________Date:______________

I DO NOT give my consent for my student to be given medical aid, if necessary, during any EMH sponsored athletic team activity. X_____Initial

I hereby give my permission for my son/daughter (name)________________ to participate in the activities for which I am registering them and hereby waive, release, and discharge any and all claims or rights to claims for damages, personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of said minor’s participation in said activity.  This release is intended to discharge in advance EMH Sports and Fitness Institute, its agents or representatives, any other promoters or sponsors of said activity. I further understand that accidents can occur during said activity, and that participation in said activity may lead to personal injury as a consequence thereof.  Knowing these risks, nevertheless, on behalf of said minor child, I hereby agree to assume those risks and to release and hold harmless all persons or entities mentioned above for damages. My signature on this form shall constitute an informed and knowing waiver as required by law. X_____InitialParent/Guardian Signature:___________________________________Date:_________

 

 

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REGISTRATION FORM - P.E. Class                                                 

P.E. Location:___________________________________________

Payment Type:  P.O.__________VCI/EU/EMR___________Check___________Other___________

PLEASE PRINT:

Name:______________________________________________School___________ Grade:___

Name:______________________________________________School___________ Grade:___

Name:______________________________________________School___________ Grade:___

Name:______________________________________________School___________ Grade:___

Address:_________________________________Phone____________City__________Zip____

Parent/Guardian(s):___________________________________Email_____________________                                              

(For Confirmation Info. Only) 

Please make checks payable to EMH Sports.

Or send form via mail

Linda and Mark Hollis

EMH Sports

Address: 33205 Vermont Road

             Temecula, CA 92592

Telephone No: 951-302-5296

Fax No: 951-344-8263

Email Address: EMHSports@aol.com

Web Site: www.emhsports.com

 

 

Please mail registration form to EMH Sports and Fitness Institute, 33205 Temecula Creek Road, Temecula, CA 92592. Questions: 951-302-5296 or email EMHSports@aol.com