RSMG Select Participation Waiver

Number of participants (Move dial to right for more than one participant)

Selected Value: 1

Move the dial to the right to select multiple particpants!

Player Name #1 *

First

Last

Birth Year *

Player 1 Birth Year

Player Name #2 *

First

Last

Birth Year #2 *

Player Name #3 *

First

Last

Birth Year #3 *

Player Name #4 *

First

Last

Birth Year #4 *

Layout

Email *

Phone

Emergency Contact Name *

First

Last

Layout

Emergency Contact Phone

Name of Parent or Gaurdian *

First

Last

Comments

Current Club, Schedule Conflicts, Etc