Health Club Membership Information

Step One - M-Plex Boys "B" Jamboree - June 2-3, 2012

  
     
   
     

Team Name

    
 
Level   Gender Skill Level          
         
   
Coach's Name              
 
Address    
 
City    
 
State   Zip          
           
     
Please provide contact information:    
   
Home Phone * required
Emergency Phone
Cell Phone
Email *required
   
Assistant Coach's Name
Address
City
State   Zip
 
 
Please provide contact information:    
     
Home Phone            
Emergency Phone            
Cell Phone            
Email            
     
If you have made a hotel reservation please list the hotel name here:    
   
     

By submitting this registration you understand that any participants attending the event/program at The Mansfield Sportsplex (The M-Plex) does so at his/her own risk. The M-Plex, Set Point Athletics, directors, staff and its officers will not be held liable for any damages whatsoever arising from personal injury or property loss sustained by the participant and his/her family while attending/participating events/programs on the premises. Participants and parents assume full responsibility for all injuries and damages that occur in or about any programs on the premises. In addition, submitting this registration form acknowledges that the applicant (s) is/are in good health and is/are able to participate in a program/event that requires physical activity. Participant (s) also agree (s) to follow the rules of conduct established by The M-Plex. Failure to do so may result in suspension or dismissal from program/event/facility.

Parent/Guardian Consent: In the event of an injury, I authorize the directors and staff to act for me according to their best judgment should my son/daughter require medical treatment during my absence. I authorize The M-Plex to use any and all photographs, pictures, or likeness of me or anyone assigned guardianship to me, as they deem appropriate in it promotional materials.

  
     
Comments or Questions: