Registration form
Parent/Guardian Information
Name:
*
First Name
Last Name
Street Address:
*
Street Address
Street Address Line 2
City/Town
State
Zip Code
Mobile no.
*
Alternate Mobile no.
parent/guardian
Emergency contact no.
*
for emergency use only
E-mail:
*
Alternate E-mail
Relation:
*
Mother
Father
Other
Player Information
New Player
Regular Player
Name:
*
First Name
Last Name
Date of Birth:
*
/
Month
/
Day
Year
Date Picker Icon
Gender:
Male
Female
Height:
*
Weight:
*
School Name:
*
School Address:
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
School Contact No.:
*
Contact Person Name:
*
designation
Grade:
Age:
*
Shirt Size(in cms):
Short Size:
If any (Medical problems/physical limitation):
Enrolment option
Terms & Conditions
We,the registrant and registrant's legal parent or guardian,hereby agree and acknowledge the followiing: (1) We agree to abide by the rules of WSA and its affiliated organizations and sponsors. (2) We recognize the inherent risk of serious or permanent physical injury associated with the sports activities and games.In consideration for WSA accepting the young player's registration and participation in its sanctioned young leagues,tournaments and team travel activities("WSA Programs"),we hereby release,discharge,and/or otherwise indemnify and hold harmless WSA ,its affiliated organizations and sponsors, volunteers,their employees and associated personnel, including the owners of field and facilities utilized for the WSA programs,against any claim, lawsuit or written demand,including but not limited to any claims for personal or physical injury, by or on behalf of the registrant as a result of the registrant's participation in the WSA Programs and/or being transported to or from the same,which transportation we hereby authorize. (3) We authorize verification of the registrant's date of birth from legal records to be provided to a WSA authorized representative for the limited purpose of verifying the WSA player's age and identity. (4) We consent to emergency medical care prescribed by a duly licensed Health Care Provider. This care may be given under whatever conditions are necessary to preserve the life,limb or registrant's well being and we hereby agree to be financially responsible for all costs associated with such treatment. (5) We consent to WSA taking photographs,video recordings, and/or sound recordings in documenting the activities of WSA programs and services.We hereby grant WSA and their affiliates' permission to use the digital media ,prints, motion pictures, video/audio tapings, or any other reproduction of the same for WSA and its affiliates''educational and promotional purposes in manuals, on flyers, the internet, or other publications. We have read this release and waiver of liability and fully understand its terms. We understand that we waive substancial rights by signing this form. We agree to waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury of any kind. We sign this release from freely of our own free will. **The payment in USD is including taxes.
*
TICK THIS BOX TO ACCEPT THE TERMS AND CONDITIONS OF REGISTRATION ON BEHALFOF THE REGISTRANT
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Wallabies coaching program - 2000 INR** (billed in USD)
(
$
33.93
one-time payment)
Wallabies 3 month program - 5000 INR** (billed in USD)
(
$
79.30
one-time payment)
Total
$
0.00
Submit
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