All Abilities Foundation of Greater Philadelphia

2019-2020 Sports Program Registration^*

Child's First Name^*

Child's Last Name^*

Child's Gender^*

Male
Female

Child's Age^*

Child's School^*

Child's Grade^*

Parent/Guardian Name(s)^*

Parent Email^*

Additional Email

Address

Address Line 1

Address Line 2

City

State or Region

Zip

Cell Phone^*

Alternate Phone

Health Insurance Provider^*

Insurance Provider Phone^*

Name of Primary Policy Holder^*

Group & Policy Number(s)^*

Insurance Provider Address^*

Please list any known allergies or medical conditions:

The following items include: the General Release and Waiver, Photo Release, and Code of Conduct Agreement as well as Information Sheets about Sudden Cardiac Arrest and Concussions. All items must be checked in order to participate in the sports program. All items, when checked, serve as your digital signature of agreement.

General Release and Waiver^*

I have read and agree

I, as parent or guardian of the aforementioned child, hereby give my approval to his or her participation in any and all of the activities of this program during the season. I assume all risks and hazards incidental to the conduct of the activities and transportation to and from the activities. I do further hereby release, absolve, and hold harmless the All Abilities Foundation of Greater Philadelphia, the parish CYO, its Athletic Association, the respective parishes, organizers, and coaches. In case of injury to my son or daughter, I hereby waive all claims against the organizers, coaches, or anyone appointed by them. I likewise waive, to the extent not covered by liability or accident insurance, any claim against any person transporting my son or daughter to and/or from the activities. I assume responsibility for all medical payments. In my absence, I hereby give permission for my child to be treated in the event of a medical emergency, and have read, understood, and agree to the General Release and Waiver as evidenced by checking this box. [Revised 10/26/2018]

Photo Release^*

I have read and agree

I consent and hereby grant the All Abilities Foundation of Greater Philadelphia, the Archdiocese of Philadelphia, the Office of Youth and Young Adults, its affiliate organizations, its Officers, Agents, Employees and Assigns the right to take photographs of me or my child (or person for whom I am legal guardian) in connection with this program. I hereby grant the All Abilities Foundation of Greater Philadelphia permission to use my or my child’s likeness in a photograph in any and all of its publications including but not limited to all of its printed and digital publications. I understand and agree that any photograph using my or my child’s likeness will become property of the All Abilities Foundation of Greater Philadelphia and will not be returned. I hereby irrevocably authorize the All Abilities Foundation of Greater Philadelphia to edit, alter, copy, exhibit, publish, or distribute my photos for the purpose of publicizing its programs or for any other related, lawful purpose. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally I waive any right to royalties or other compensation, financial or otherwise, arising or related to the use of the photograph. By agreeing to this release, I confirm that this consent has been explained to me in terms which I understand.  [Revised 11/10/2019]

Code of Conduct Agreement^*

I have read and agree

The All Abilities Foundation of Greater Philadelphia’s Sports Program focus is on inclusion, acceptance, and community without judgment. Our objective is to foster growth and development of all participating members of the program. In participating in the Sports Program, I understand that the program is not a drop-off program and that a parent, guardian, or other responsible adult must be present for the duration of each activity. In addition, I pledge the following: To respect the volunteers in the program who are reaching out to young people through athletics. To respect and support all teammates regardless of ability or skill level. To set the standard for exemplary sportsmanship behavior, including the demonstration of the highest respect for officials and opponents. To show appreciation for the significant contributions of coaches, volunteers, parents, and others to the success of the program. To respect all facilities and equipment used in support of the program. Failure to adhere to these principles and guidelines may result in suspension or dismissal from the program. By signing this agreement, I acknowledge I have read the above statements, have discussed it with my child, and will abide by this Code of Conduct Agreement.  [Revised 11/10/2019]

Sudden Cardiac Arrest Information Sheet: click here^*

I have reviewed and understand the symptoms and warning signs of Sudden Cardiac Arrest

Please review the Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet through the link provided to your left.

Concussion & TBI Information Sheet: click here^*

I acknowledge that I am familiar with the nature and risk of concussion and traumatic brain injury

Please review the Concussion and Traumatic Brain Injury Information Sheet through the link provided to your left.

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