Menu
Premier Sportplex
Home
Volleyball
Youth Leagues
Homeschool Summer League
Open Gym
Tournaments
Futsal
Futsal Youth League
Futsal Open Gym
Futsal Combine
PickleBall
Summer Camp
Lab School
MOTHERS DAY OUT
Basketball
Dance
Homeschool Opportunities
Partners
Premier Power House
Birthday Parties
Contact
Home
Volleyball
Youth Leagues
Homeschool Summer League
Open Gym
Tournaments
Futsal
Futsal Youth League
Futsal Open Gym
Futsal Combine
PickleBall
Summer Camp
Lab School
MOTHERS DAY OUT
Basketball
Dance
Homeschool Opportunities
Partners
Premier Power House
Birthday Parties
Contact
BASIC INFORMATION
*
Indicates required field
Child's Name
*
First
Last
Date of Birth
*
Mother's Name
*
First
Last
Phone Number
*
Email
*
Father's Name
*
First
Last
Phone Number
*
Email
*
Emergency Contacts / Permission to Pick Up:
Name
*
First
Last
Phone Number
*
Relationship
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name
*
First
Last
Phone Number
*
Relationship
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Health Information
Physician's Name
*
First
Last
Phone Number
*
Special Health Needs/Allergies
*
Photo Release
I give permission for Rise and Shine to use photographs of our child(ren) on the SportsPlex website and /or any fliers, brochures, or any other publication relative to Rise and Shine
Choose One
*
yes
no
Consent to Treatment
I understand every effort will be made to reach me int he event of an emergency. If I cannot be reached, I give permission for the Director(s) of Rise and Shine to act on my behalf of my child to receive medical care. I authorize and consent to medical, surgical, and hospital care to be performed for my child by medial staff to safeguard my child's health. I waive my right of informed consent to such treatment. I also give permission for my child to be transported by ambulance if needed.
Choose One
*
Yes
No
Submit