EM3 SPORTS CLUB (6th Grade Only)
Please complete this form if you have interest in being a member of the 6th grade Sports Club at East Millbrook.  The club will run for 3 weeks (May 13-May 31) from 245-430.  You must have a ride home because there are no after school activity buses.  The schedule will be as follows: Mon & Wed basketball/soccer, Tues & Thurs volleyball/football.  All members are required to be passing all core courses and have no discipline referrals on meeting days. If you have any questions, please reach out to Coach Dargan (cdargan@wcpss.net)
Email *
Student First Name *
Student Last Name *
Parent Email *
Parent Phone Number *
In which sport are you interested in participating in? *
In which sport are you interested in participating in? *
Do you have any physical limitations? Ex. Asthma, previous injuries/broken bones/concussion, sickle cell anemia etc.  If YES please describe *
EM3 SPORTS CLUB MEMBERSHIP WAIVER
This is a legally binding release made by me to East Millbrook Magnet Middle. I fully recognize that there are dangers and risks to which I may be exposed by participating in the practice, competition and/or other activities of the EM3 Sports Club. Example of these dangers and risks are injuries or conditions including, without limitation, muscle or ligament damage, lacerations, abrasions, contusions and fractures, heart attack, as well as other injuries or conditions up to and including serious injury or impairment to my body, general health and well-being or loss of life. I understand that the school does not require me to participate in the Club or in these activities, but I want to do so, despite the possible dangers and risks and despite this Release. I therefore agree to assume and take on myself all of the risks and responsibilities in any way associated with my participation in the Club. In consideration of and return for the services, facilities, equipment or other things provided to me by the University, I HEREBY RELEASE EAST MILLBROOK MAGNET MIDDLE (coaches, staff, admin) FROM ANY AND ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME, FROM MY DEATH OR FROM DAMAGE TO MY PROPERTY, IN CONNECTION WITH MY PARTICIPATION IN THE CLUB. I UNDERSTAND THAT THIS RELEASE COVERS LIABILITY, CLAIMS, AND ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURES TO ACT OF THE SCHOOL, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE BY THE SCHOOL. I recognize that this Release means I am giving up, among other things, rights to sue the School or School system for Injuries, damages, or losses I may incur. I also understand that this Release binds my parents/guardians as well as myself. I further acknowledge that to the best of my knowledge, information and belief, I am physically able to participate in the Club without any undue or unusual risk to others or me. I acknowledge that the school has recommended that I consult with, and have a physical examination conducted by, a physician before I engage in any of these activities. I have read this entire Agreement to Participate; I fully understand it and I agree to be legally bound by it.

I have read and agreed to the EM3 Sports Club Membership Waiver *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wake County Public School System. Report Abuse