Home Phone: ____________________School:__________________
Parent/Guardian Name: ____________________ Emerg. Phone:
1. I do realize that there is risk of injury when
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: