Player Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Legal Guardian *

First Name

Last Name

Parent #1 Phone *

(###)

###

####

Parent/Legal Guardian #2

First Name

Last Name

Parent #2 Phone

(###)

###

####

Other Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

I hereby give my permission for [named player] to participate in the LIGHTNING Football program. I understand that, in the event that medical treatment is required, every effort will be made to contact me. If I cannot be reached, I give my permission to the sponsor to give first aid to my child and/or to secure the service of a licensed medical care provider to provide the care necessary, including anesthesia, for my child’s well-being. I also understand that all medical expenses will be my responsibility, and that no member of the Lightning Football organization will be held responsible for medical expenses. *

Yes

Primary Doctor *

First Name

Last Name

Primary Doctor Phone *

(###)

###

####

Dentist *

First Name

Last Name

Dentist Phone *

(###)

###

####

Date of last tetanus shot *

MM

DD

YYYY

Parent/Guardian Signature *

Your typed name below is considered your digital signature.

First Name

Last Name

Today's Date *

MM

DD

YYYY

I represent that I am a legal, responsible adult. I represent and warrant that I am signing this document for myself and my children for facility use by the Lightning Flag Football program, to include, but not limited to, training properties, practice properties, and game fields. I am fully aware of the risks and dangers of such usage. I understand that the usage of the facilities is voluntary, at my and my children’s own risk, and that the Lightning Flag Football program is not responsible in any manner for my children’s usage of any such facility. I further understand that I am solely responsible for any personal injury or property damage caused by me or my children as a result of the usage of any such facility. I acknowledge that, in the middle of a global pandemic, there is a serious risk that, by using the facility, I or my children could contract a dangerous virus or other health condition, and that I accept this risk and nonetheless voluntarily choose to allow my children to use the facility. In consideration of my children being allowed usage of any property or facility and for other good and valuable consideration, receipt of which is hereby acknowledged, on behalf of myself, my children and all others who may claim by, under, or through myself I do hereby agree to indemnify and hold harmless and do hereby release, acquit, and forever discharge the Lightning Flag Football program and all of its officers, employees, agents, and assigns, and all other persons or companies from any and all claims, actions, or causes of action which I or my children now have, or which may hereafter accrue, whether for personal injury or property damage, whether known or unknown, arising out of or in any way resulting from my and/or my children’s usage of any property or facility during the spring, summer and fall months of 2025. I understand and agree that my signature below represents a signature on behalf of myself and each of my children.

Signature of each parent or guardian: *

First Name

Last Name

Additional Parent/Guardian Signature

First Name

Last Name

Name of each child *

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name