Registration Form

Participants Name (required)

School/Site Attending (required)

Home Address (required)

City (required)

State (required)

Parent/Guardian Name (required)

Phone Number (required)

Email Address (required)

Emergency Contact Name (required)

Emergency Contact Phone Number (required)

Age/Grade (required)

I give permission to photograph my student participating in the Kids on the Ball Program
YesNo

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 hereby give permission to KOB staff to act as first responder in seeking and providing emergency medical attention.
YesNo

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.
YesNo

Any Additional Information you would like Kids on the Ball to be Aware of :

Kids on the Ball Registration

Price: $120

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