EBFEnrollment

Enrollment for classes at NTA Sports Facility
Only!

Child 1 Name: First, Last

Current Age:

		Cls Room:

Birthday

	Male

	Female

Child 2 Name: First, Last

Current Age:

			Cls Room:

Birthday

	Male

	Female

Child 3 Name: First, Last

Current Age:


			Cls Room:

Birthday

	Male

	Female

Class to be Enrolled In:

Street Address:

Mother's Name:

Home Number:

Street Address:

City, State, Zip

Home Phone:

Work/Cell Phone:

Primary Email Address:

Secondary Email:

Father's Name:

Home Number:

Street Address:

City, State, Zip

Home Phone:

Work/Cell Phone:

Primary Email Address:

Secondary Email:

Choose Your Child's
Shirt Sz:

	Child 1:




	Child 2:

Child 3:

Consent for Media
Usage:

Occasionally,Play For Staff, Inc. staff may photograph students with the intent of using the pictures in
various publications and/or on our web site (www.playforsport.com). Similarly, Play For Sport, Inc. may
wish to promote our student's accomplishments by sending press releases to appropriate newspapers
or publications. In addition, representatives of the media may be interested in stories relating to Play For
Sport, Inc.and may wish to interview, photograph or videotape our students. Please complete this form
and return it to your teacher. Non-response to this request will indicate that you grant permission as
indicated below.

I HEREBY:			Permission for press releases to be distributed about my son/daughter, and for photographs of and/or interviews with my child to appear in other mediums for as long as my child(ren) is enrolled in Play For Sport, Inc.
	Grant


		Do Not Grant

Physical Limitations:

Play For Sport, Inc. is a physically active program. Please list and describe below any injuries, allergies, or
health conditions which might limit your child’s participation.

Parental Consent:

I understand all fees are due in advance and that they are due regardless of absences. Any missed
classes must be made up within 30 days. AND I, the minor's parent and/or legal guardian, understand
the nature of the above referenced activities and the Minor's experience and capabilities and believe the
minor to be qualified to participate in such activity. I HEREBY release and hold harmless Play For Sport,
Inc. and all its employees in the event of accidents and/or injuries that are caused or alleged to have been
caused by my child's participation.

		I accept and agree to the terms outlined above and certify that all information provided on this enrollment form is true and correct as of the date the enrollment form was submitted.

COACHING STAFF
CERTIFIED THROUGH
NYSCA

We Are Honored
to Support