This form must be accompanied by your registration fee. The fee is $95 per child.
| Name Of Registrant: | Telephone: ( ) |
| Address: | Sex: Male / Female |
| Town, State, Zip: | E-Mail Address: |
| Parent's Names: | Birth Date (year, month, day): |
PLEASE CIRCLE DESIRED PLAYING SESSION
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TIME FOR YOUR CHILD
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Note: This Statement MUST be signed by parent or guardian for a minor and by coach or administrator for himself / herself.
I, the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant will abide by the rules of Rocket Sports. Recognizing the possibility of physical injury associated with sports activities and in consideration for Rocket Sports accepting the registrant for their sports programs and activities (the "Programs"), I hereby release, discharge and / or otherwise indemnify Rocket Sports, their affiliated organizations and sponsors, employees and associated personnel, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs.
| Parent / Guardian Signature: | Date: ____ ____ ____ |