AAU – 9th Grade Boys (Rheingold)

Player First Name^*

Player Last Name^*

Gender^*

Birthday^*

Current Grade^*

Player Email Address

Players Phone Number

Mother's First Name^*

Mother's Last Name^*

Mother's Cell Phone^*

Mother's Email^*

Father's First Name^*

Father's Last Name^*

Father's Cell Phone^*

Father's Email^*

Emergency Contact^*

Emergency Number^*

Address^*

Street Number

Street Address

City

State

Country

Zip Code

Program

Jersey Size^*

Shorts Size^*

Medical Alerts/Conditions^*

Terms & Conditions^*

As a participant in the above program, I recognize and acknowledge that there are certain risks of physical injury. I agree to assume the full risk of any injuries, damages or loss which I or my child may sustain as in result of such participation. I further understand that the East Coast Panthers, LLC provides secondary insurance to my primary insurance coverage for any injuries that may be sustained. I agree to waive and relinquish all claims and hold harmless the East Coast Panthers, LLC, its officers, agents, and employees from any and all claims.

Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu. .rm_next_btn {display:none !important} .rm_noscript_btn {display: block !important}