NSL OFFICIAL REGISTRATION
TEAM ______________________________________
AGE GROUP________________________________
Print Participant's Name
________________________________
Student ID # ___________________________
All Participants must have insurance to participate!! Does your child have medical insurance? (Check one)
_____Yes. Current medical insurance provider___________________________________________________
_____No. I would like information on attaining insurance.
Current medical conditions (e.g. Allergies or illnesses)
______________________________________________
Emergency Contacts
Parent/Guardian's name. Parent/Guardian's Phone Number(s)_________________________________________
Other to contact in case of emergency
______________________________________________________________________
________________________________
____________________
__________________________
Relationship
Phone # 1
Phone #2
I trust the judgment of this organization to discipline when necessary, in order to maintain the integrity of the event, the facility and this organization. I hereby allow the NSL to verify my child's age through school's records in order to
establish eligibility.
I hereby certify that I have read this document; and, I understand its' content.
__________________________________________
________________________
Participant's Signature
Date
__________________________________________
________________________
Parent's Signature
Date
(for participants under 18 years old)
Please See Other Side for Photo & Birth Certificate