Put Me In Coach!!
Child 1 Name:  First, Last
Current Age:
Cls Room:
Birthday
Male
Female
Child 2 Name:  First, Last
Current Age:
Cls Room:
Birthday
Male
Female
Child 3 Name:  First, Last
Current Age:
Cls Room:
Birthday
Male
Female
       
Childcare Facility:
Street Address:
       
Mother's Name:
Home Number:
Street Address:
City, State, Zip
Home Phone:
Work/Cell Phone:
Primary Email Address:
Secondary Email:
       
Father's Name:
Home Number:
Street Address:
City, State, Zip
Home Phone:
Work/Cell Phone:
Primary Email Address:
Secondary Email:
       
Choose Your Child's
Shirt Sz:
Child 1:
Child 2:
Child 3:
       
Consent for Media
Usage:
 Occasionally,Play For Staff, Inc. staff may photograph students with the intent of using the pictures in
various publications and/or on our web site (www.playforsport.com). Similarly, Play For Sport, Inc. may
wish to promote our student's accomplishments by sending press releases to appropriate newspapers
or publications. In addition, representatives of the media may be interested in stories relating to Play For
Sport, Inc.and may wish to interview, photograph or videotape our students. Please complete this form
and return it to your teacher. Non-response to this request will indicate that you grant permission as
indicated below.
 
I HEREBY:
 Permission for press releases to be distributed about my son/daughter,
and for photographs of and/or interviews with my child to appear in other
mediums for as long as my child(ren) is enrolled in Play For Sport, Inc.
Grant
Do Not
Grant
Physical Limitations:
 Play For Sport, Inc. is a physically active program. Please list and describe below any injuries, allergies, or
health conditions which might limit your child’s participation.
 
Parental Consent:
 I understand that Play For Sport is a voluntary enrichment program and I agree to pay for my
child’s participation. I understand all fees are due in advance and that they are due regardless of
absences. I acknowledge that my tuition is due by the first of each month and that a late fee of $10 will be
applied to any and all payments received after the 10th of each month. AND I, the minor's parent and/or
legal guardian, understand the nature of the above referenced activities and the Minor's experience and
capabilities and believe the minor to be qualified to participate in such activity. I HEREBY release and hold
harmless Play For Sport, Inc. and all its employees in the event of accidents and/or injuries that are
caused or alleged to have been caused by my child's participation.
 
I accept and agree to the terms outlined above and certify that all information provided on this
enrollment form is true and correct as of the date the enrollment form was submitted.
 
 
       
       
       

COACHING STAFF
CERTIFIED THROUGH
NYSCA
We Are Honored
to Support
TM