Athlete Waiver Form

No athlete will be permitted to participate in any NCSAA tournament if NCSAA does not have a completed, current, and valid form on file for that athlete. No registration fees will be refunded for any athlete or team that is unable to participate in part of all of any tournament due to the failure to complete and file the Athlete Waiver Form. A new form must be submitted for every tournament that the athlete attends.

A separate form must be completed and submitted for each athlete.

This form MUST be completed by the player's parent or legal guardian. Completion of the digital signature certifies that the form has been completed by the person whose name and initials appear in the digital signature area. (If a paper form was completed by the parent/guardian, and then the online form was completed by another person, the paper form must be brought to the tournament and given to NCSAA at on-site registration.)

Please complete this form and then press "Submit" below.

If you have any problems with this form, please contact us to resolve those issues. No athlete will be excused from submitting a form due to problems with the form. Please contact NCSAA to resolve any issues ahead of time.

* indicates a required field

Player's first name:*

Player's last name:*

Grade in school:*

In which tournament will the be player be participating?*

Players School*

Player's home address:*

City:*

State:*

Zip Code:*

Player's email address:*

Names(s) of parent(s) / guardian(s) with whom player lives:*

Parent / guardian home phone number (Format: XXX-XXX-XXXX):*

Parent / guardian cell phone number (Format: XXX-XXX-XXXX):*

Name of person to call, in case of an emergency, if parents can't be reached*

Phone number(s) of person to call, if parents can't be reached:*

I understand, by the nature of the activity, that there is a possibility of accident, and I assume the risk and responsibility while my child attends this tournament. I hold harmless NCSAA and/or its representatives, as well as the host facility/school and its representatives, for any injury that my child may sustain during participation in this tournament. I also forfeit legal action or compensation claims against NCSAA and/or its representatives, for injuries my child may sustain. I, as parent/guardian of this minor student, consent to emergency care to be administered to the minor as deemed necessary by the involved physician and/or hospital which is to administer the required treatment of the emergency condition. I also understand that all incurred costs are my personal responsibility, and that NCSAA and the host facility/school and coaches do not have medical insurance coverage for injuries to the minor as a student participant. (If the student is not a minor, he/she may sign here for himself/herself -- indicated agreement to the above statements on his/her own behalf.)*

Please initial to indicate your agreement.

Health Insurance Carrier:*

ID Number:*

Group Number:*

If any of the above boxes are not applicable to your health insurance coverage, please type "N/A" into the appropriate boxes above. If the athlete does not have health insurance coverage, please type "No Insurance" into the boxes above, and provide explanation here.

Physician's name:*

Physician's phone number (Format: XXX-XXX-XXXX):*

Date of birth:*

	MM	DD	YYYY
	/	/

Medications:

Allergies:

Important medical history:

Any other medical conditions:

I certify that I am the parent / guardian for the dependent child above. I also certify that this dependent child has had a physicl examination and is physically fit and able to participate in the activities. I also certify that this form has been completed by the person whose name and initials appear below, and that all information provided here is complete and accurate, to the best of my knowledge. (An athlete who is not a minor may certify and sign for himself/herself, in regard to the previous statements.)*

Please initial here to indicate your agreement.

Parent / guardian name: (Typing your name here indicates your digital signature)*

Parent / guardian's initials: (Typing your initials here indicates your digital signature)*

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