REGISTRATION FORM

Participant’sName:_____________________________Age:________DOB:_____________

Address: ____________________________________City:______________ Zip: _________

Home Phone: ____________________School:__________________ Grade:__¬¬___________

Parent/Guardian Name: ____________________ Emerg. Phone: ____________________

                                         
                                            PARENT CONSENT
                                               (Parent/Guardian Responsibilities)

1.    I do realize that there is risk of injury when participating.
2.    I agree to hold harmless the City of Paterson/Rising Stars Foundation and the associates of the league with respect to any physical injuries occurring from participating.
3.    Permission is also granted to provide emergency medical attention for my child.
4.    In case of a medical emergency, I/We hereby authorize any local hospital, doctor or licensed medical practitioner, as well as a Rising Stars EMT Personnel, to aid in the health and wellbeing of my child.

Parent/Guardian Signature_______________________________ Date: ___________