Registration & Contact Us

Participant's Name: *

First

Middle Intial

Last

Parent's Full Name: *

Address

Street Address *

Address continued

City

State

Zip

Phone #:

Home Phone: *

Emergency Phone: * -

Emergency Contact Name: *

e-mail address: *

Youth's Grade: *

Name of School Attending *

Youth's Age: *

Participant's Experience Level: Beginner:Intermediate:Advanced:

I understand and accept that there are risks involved in participating in any recreational activity. I am aware of those risk, and I am voluntarily participating in this activity with knowledge of all risk involved. I agree to accept any and all such risk of injury, death and/or property damage. I agree to the terms of this waiver, release, covenant not to sue and indemnity agreement as set forth herein. In case of injury or illness, I give my consent to emergency transportation and administration of first aid, medical and or dental treatment. I accept responsibility for the payment of any emergency transportation, treatment expenses and any related or subsequent medical and/ or dental bills. ATL Youth Sports as not purchased and does not provide medical or accidental insurance to cover such expenses. Any such insurance is my responsibility. I waive, release, absolve indemnify and agree to hold harmless, ATL Youth Sports, its members, officers, directors, employees, volunteers, agents and any other representative of ATL Youth Sports against any and all cause of action, claims, demands, losses, expenses, ability. In addition, I understand my conduct, if deemed inconsistent with the rules of good conduct and sportsmanship requirements of ATL Youth Sports may result in my dismissal from the program at not refund of registration fees.

Amount Paid: Minimum Non-refundable $50 deposit is required, remaining balance due the week the program starts. $165 Credit Card (Through Paypal)$165 Check Mailed$55 NR Deposit Credit Card (Paypal) $55 NR Deposit Check In MailPlease call to take credit card over phone$110 Returning RamMore than one child enrolled

Check Payment Mail: Payable To: ATL Youth Sports ATL Youth Sports 3014 Nantcket Dr. Joliet IL 60435 Applications will not be processed without payment.