ANNUAL WMMHS DODGEBALL TOURNAMENT WAIVER I give my child/ward ________________________________ permission to participate in the (PRINT Student Name) Mendham High School’s Annual Dodgeball Tournament on June 9th, 2015. I understand the activity will be supervised and the school DOES NOT INSURE participants with accident insurance and that students participate at their OWN RISK. It is understood that this program is a physical activity and various injuries may occur. I also understand it is my responsibility to make sure the registrant is physically capable of participating in this program and a medical physical by a doctor is recommended. I understand that my child must complete the registration form on the back of this waiver and that all information submitted is, to the best of my knowledge, true and correct. Any intentional falsifying of information will result in automatic expulsion of my child/ward from the program and possible persecution. I agree to abide by rules, regulations, and policies as set forth. I also understand that myself and my child must sign the school’s code of conduct in order to participate in this event. I agree to pick up my child or arrange for someone to pick up my child at the conclusion of the last game of the night. Parent/Guardian Signature: ______________________________________________________ Parent/Guardian Printed Name: ___________________________________________________ Please complete the registration form on the back and the school Code of Conduct, regardless of if you have already signed it for another club, activity or sport. ANNUAL WMMHS DODGEBALL TOURNAMENT PLAYER REGISTRATION INFORMATION Last Name:_________________________________________________ First Name:_________________________________________________ Current Grade:______________________________________________ Student Email:______________________________________________ Age:_____________ Date of Birth:________________________ Home Phone:______________________________________________ Emergency Phone:__________________________________________ Parent/Guardian Name:____________________________________________________ Medical Needs/Problems:_____________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________
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