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BRAZUSA
AFTER SCHOOL SPORTS PROGRAM
@The Varnett Public School (Southwest campus)
HAGAMOSLO ORGANIZATION
REGISTATION AND Liability Waiver FORM
PARENT OR GUARDIAN FIRST AND LAST NAME
Address
Email
Phone
Do you have a doctor’s permit to participate in intense physical activities?
No
Yes
1. ATHLETE FIRST/LAST NAME
Date of Birth
2. ATHLETE FIRST/LAST NAME
Date of Birth
3. ATHLETE FIRST/LAST NAME
Date of Birth
PLAYER # 1
MALE OR FEMALE
M
F
CHOOSE SHIRT SIZE
S
M
L
XL
PLAYER # 2
MALE OR FEMALE
M
F
CHOOSE SHIRT SIZE
S
M
L
XL
PLAYER # 3
MALE OR FEMALE
M
F
CHOOSE SHIRT SIZE
S
M
L
XL
Please specify anything we should know about
I declare that the info I’ve provided is accurate & complete
I the parent/guardian of the athlete(s) listed in these aplication ahereby acknowledge this release from liability for accidental injury or illness which may incur as a result of participating in any physical activity. I am exercising my own free choice to permit my child to participate voluntarily in the Hagamoslo After School Programs. I hereby release and discharge, indemnify and hold harmless the State of Texas and those acting through the Board of Trustees of Hagamoslo Organization, Brazusa LLC, The Varnett Public School Southwest campus and their officers, agents, employees, and any other persons or entities acting on their behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against all claims, demands, and causes of action whatsoever, either in law or in equity, relating to injury, disability, death or other harm, to person or property or both, arising from my participation in and/or presence at the above listed activities. I acknowledge that I am aware of any hazards and risks which may be associated with my participation in the above named activities and am unaware of any health issues that would preclude participation.
Initials
Select an item ($)0.00
*
SINGLE PLAYER REGISTRATION - $180
TWO PLAYERS REGISTRATION - $300
3 PLAYERS REGISTRATION - $420
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