Waiver Form

CT Express Waiver Form

Participants Name:
Date of Birth
 / 
 / 
School
Gender
Age
Grade
Guardian*
Email:*
Home
Mobile*
Emergency Contact
Phone:
Relationship
Allergies
Special Medical/Physical Conditions
Hospital Preference
Physician
Town
Phone
Athlete's Waiver. Pledge and Consent Agreement While youths are responsible for their own behavior, as a parent and/or legal guardian, I remain legally liable for any actions or damages made by the above named minor. I am aware that I will be called if my child breaks any of the rules and has to be sent home. I agree on behalf of myself, my child named herein, our heirs, successors and assign's to hold harmless and defend CT Express, its administrators, directors and representatives associated with my child attending this event or in connection with any illness or injury of cost or medical treatment in connection there with. I hearby warrant that to the best of my knowledge, my child is in good health and physical condition and he/she has no disease or injury that would restrict his/her participation in activities related to the CT Express. I assume all responsibility of the health of my child. In the event of an emergency and I cannot be reached, I hereby give permission to transport my child to a hospital or medical facility and to seek medical attention. By entering and participating in the CT Express organization, I agree to abide by the rules and regulations of the organization, administrators and coaches.
By clicking the submit button you agree to the terms and conditions.