Participant Registration

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Email *

Parent/Guardian Full Name *

Child's Full Name *

Child's Age *

Child's Gender *

Male

Female

Phone Number *

Address *

Child's T-Shirt Size *

Youth XS

Youth S

Youth M

Youth L

Youth XL

XXL

How did you hear about this event?

Has your child played any of the sports being offered? *

Basketball

Dodgeball

Pickleball

Cornhole

Boxing

None of the above

Required

Does your child have any disabilities or limitations? Please describe. *

Does your child need any accommodations for the sports being offered? Please describe. *

Is your child able to throw a ball? *

Yes, they are able to throw a ball

No, they are not able to throw a ball

Is your child able to use a pickleball paddle? *

Yes, my child is able to hold a paddle

No, my child is not able to hold a paddle

Yes, my child is able to swing a paddle

No, my child is not able to swing a paddle

Required

We will have volunteers to personally assist children as needed. Does your child need a buddy? *

Yes, I would like my child to have a buddy assist them

No, my child does not need a buddy

What sports does your child enjoy or engage in? *

What sports would you like to see offered in the future?

Are you aware of any sponsors who would be interested in participating in this event?

We kindly request your permission to capture photos and video of your child during the event. These images may be used for promotional purposes and on our website and social media channels. By checking the box below, you grant us permission to use your child's likeness in this manner. Your support in showcasing the joy of sports for children with disabilities is greatly appreciated. *

I grant permission for my child's image to be used as described above.

Required

This Liability Waiver (the “Waiver”) is effective immediately, by you as the legal guardian and/or parent (the “Party”) who acknowledges and agrees to the terms below:

TERMS AND CONDITIONS

1. The Party willingly volunteers to join and participate in Southern Pediatric Therapy, The Gatorade Fieldhouse, and Hernando Sportsplex’s The Rising Stars Sports Program.

2. You as legal guardian and/or parent are aware and acknowledge that the Company will not be held responsible for risk, injury, or hazard that may arise during this activity.

3. The Company will not provide any compensation to the Party should a risk, injury, or hazard arise.

4. The Party expects no compensation, bonus and or reward for joining the aforementioned activity.

5. There is no solicitation that the Company requires for the said activity. Therefore, the Party is responsible for their own budget and expenses during the activity.

I acknowledge and agree to these terms.

Required

*Please Sign:

Parent/Guardian Name

Date: *

YYYY

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