Winter Holiday Sign Up

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Winter Holiday Camp Sign Up Form

Player Name*

Birthday*

Month

Day

Year

Parent/Guardian Name*

Contact Number*

Email*

Emergency Contact Name*

Emergency Contact Number*

Select date/s of training

Monday, Dec 22

Tuesday, Dec 23

Wednesday Dec 24

Monday, Dec 29

Medical Information

Does the player have any allergies, chronic illnesses, or other medical conditions? *

YES

NO

If Yes, please specify

Is the player currently taking any medication?

YES

NO

If Yes, please specify

Does the player have any history of concussions or significant injuries? *

YES

NO

If Yes, please specify

Consent & Agreement

I, the undersigned, acknowledge that I have read and understood the DAS Academy Code of Conduct and agree to abide by the rules and regulations set forth by the club.

I consent

Medical Authorization

In the event of an injury or illness during training or matches, I authorize DAS Academy staff to seek medical treatment for my child as necessary.

I consent

Liability Waiver

I have read the DAS Academy Liability Waiver and agree to the terms outlined here

I have read and accept the DAS Academy Liability Waiver

I, the undersigned, acknowledge that I have read and understand and agree to all the terms above*

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