Registration Form
Registration form
First name  *
Last name  *
School/Site Attending  *
Address  *
Parent/Guardian Name  *
Phone #  *
Emergency Contact  *
Emergency #  *
T-Shirt Size (if included)
Age & Grade  *
Health Insurance Company  *
Policy #  *
I give permission to photograph my student participating in the Kids on the Ball Program  *
In case of a medical emergency, I understand every effort will be made to contact parents. In the event that I cannot be reached, I heareby give permission to KOB staff to act as first responder in seeking and providing emergency medical attention.  *
Insurance Waiver- I understand that I will provide and pay for all medical treatment for my student and will not hold Kids on the Ball, coaching staff, or facility responsible for injuries incurred by my student while in the attendance of the KOB program.  *
Any Additional Information you would like Kids on the Ball to be Aware of:
* Required fields
Please fill in the form below. Fields marked with * are mandatory.

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