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Futsal
Home
Summer Camp
Volleyball
Youth Leagues
Indoor Volleyball Camps
Open Gym
Lab School
MOTHERS DAY OUT
Birthday Parties
Basketball
Homeschool Opportunities
Partners
Premier Power House
Contact
Futsal
BASIC INFORMATION
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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
*
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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.
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Days you are enrolling in
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Tuesday
Wednesday
Thursday
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