EmailMe Form - #1: Registering for the First Time

PARENTS INFORMATION

Mothers Name

Fathers Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Cell Phone Number #1 *

### - ### - ####

Cell Phone Number #2

### - ### - ####

Email #1 *

Email #2

How many Children are you registering? *

USC_CV: 1 child only

USC_CV: 2 children

USC_CV: 3 children

Would you (or another family member) want to be become a Volunteer Coach? *

Yes - I want to Volunteer

No - not this time

Upon Completion of the program you will be reimbursed your Childs Regisitration fee.
*You will be Trained, Fingerprinted and Screened by the City Prior to Coaching

CHILD #1 INFORMATION

#1: Child's Full Name *

Date of Birth *

School Name *

School Grade *

Shirt Size *

CHILD #2 INFORMATION

#2: Child's Full Name

Date of Birth

School Name

School Grade

Shirt Size

CHILD #3 INFORMATION

#3: Child's Full Name

Date of Birth

School Name

School Grade

Shirt Size

INSURANCE INFORMATION

Do you need ALM Sports Insurance?
ALM Insurance cost $40 to cover the first 6 months as a primary - the total program for the family (training sessions + games) *

Yes, ALM Sports Insurance

No - I will use my own Insurance as Primary

USC is in partnership with ALM Sports for all Liability and Insurance Coverages

Primary Insurance Details
(your childs insurance carrier and policy number)

Medical Concerns

I have read and agree to the Terms of Service *

Yes, I agree.

If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not, We offer this through ALM Sports Insurers at a cost of $40.00 for the first 6 months of the program. Please note; your Insurance fees covers both training & game days. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow USC to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email almsportsteam@gmail.com I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.