Kickball Participant Form 2025

Night in the Dome Kickball Tournament | Friday, March 21, 2025
All players must complete the following form before a student arrives at the tournament.

*Denotes required field

Church Name*

STUDENT INFORMATION

Student's First Name*

Student's Last Name*

Student's Email Address*

Cell Phone*

May we text you?

Yes

No

Gender

Female

Male

Birthdate

Address

Country

Street

City

Region

Postal Code

High School Name*

Graduation Year*

HS CEEB (Hidden)

HS Level of Study (Hidden)

Student Type (HIDDEN)

Location (HIDDEN)

MEDICAL AND EMERGENCY INFORMATION (To be completed by parent/guardian)

Please provide any information that may affect the participant's involvement, such as:*

Medical conditions
Medications the youth will be bringing to the tournament
Any known allergies

Emergency Contact Name*

Emergency Contact Phone Number*

Do you consent to first aid being administered (e.g., ice packs, bandages)?*

Yes

No

Do you consent to administering basic over-the-counter medications (e.g., Tylenol, antacids, triple antibiotic ointment)?*

Yes

No

Does the participant have health insurance?*

Yes

No

Please provide the insurance company name and policy number below.*

ACKNOWLEDGEMENTS AND AUTHORIZATIONS

Acknowledgement of Policies

I certify that I have read and understand the above policies.*

Medical Authorization:

I authorize an adult in charge to consent to medical, dental, or hospital care (including X-rays, anesthesia, or treatment) for my child as advised by licensed medical professionals.

Expenses Liability:

I accept responsibility for all medical expenses and transportation costs if my child must return home due to medical reasons or other circumstances. I also grant permission for my child to ride in any vehicle authorized by Concordia University.

Photo/Video Release

I grant permission for Concordia University to use photos or videos of my child taken during the Kickball Tournament for promotional or educational purposes. I release the university and its representatives from all claims related to this usage.

Liability Waiver

I release Concordia University and its representatives from any claims related to injuries, illnesses, or losses incurred by my child during participation in the Kickball Tournament.

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Kickball Participant Form 2025