Child's First Name *

Child's Last Name *

Child's Birthday *

Child's Gender *
M F

Classroom # or Teacher's Name

Parent's Name *

Address *

City *

State *

--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code *

Primary Phone Number *

E-mail address *

Liability & Photo Release

 I Agree to the Liability Release *

Your child will remain under the care, direction and supervision of the school while receiving instruction from AMAZING ATHLETES. I hereby release and discharge AMAZING ATHLETES, the Childcare Facility and its members from all actions, claims, demands, injury or damage resulting from my child"s participation in this activity.

 I Agree to the Photo Release

I give AMAZING ATHLETES permission to publish pictures and/or videos of my child participating in the Amazing Athletes program.
Comments or Questions

Comments or Questions