New Heights

Application and Release

For Participation In Athletic Activities

For Year Of

August 1, 2025 to July 31, 2026

Names of Participants from the Same Family:

Grade Level of Participant = Participant’s Grade Level on August 1, 2025

Name_____________________________ Grade______

***Check here _____if you listed additional participants on the back

Parents/Guardian Information:

Name: ________________________________ Relationship___________

Home Phone __________________ Cell Phone ____________________

Email: _____________________________________________________

Name: ________________________________ Relationship___________

Home Phone __________________ Cell Phone ____________________

Email: _____________________________________________________

Permission and Release of Liability: I give permission for Participant to

participate in athletic activities and I hereby declare that I have consulted

with a physician and the Participant is physically able to participate in strenuous

activities such as competitive athletics. In the event that Participant is injured,

I waive and release all rights to any claims for damages against New Heights,

sponsors, or representatives. I understand that New Heights does not carry medical

insurance for participants or coaches and I am fully responsible for any and all

medical bills.

Medical Release: In the event that Participant suffers sudden illness, accident,

or injury, and I (Parent/Guardian of Participant) am not available and cannot be

contacted, I give permission that medical and emergency personnel be

contacted to provide medical and emergency treatment for Participant. I

understand that I am fully responsible for any and all cost for medical and

emergency treatment.

Birth Certificates: New Heights does not keep copies of birth certificates on file.

Parents and Guardians are to maintain a copy of a birth certificate for the Participant

and be willing to provide a birth certificate if one is ever needed for age verification.

List pertinent medical information or physical limitations below

and alert coaches to any serious ailments or concerns (diabetes,

allergies, asthma, etc.):

Expectations For Participants & Parents/Guardians:

New Heights participants and parents/guardians are expected to promote

good sportsmanship and character at all practices and events.

By signing this form, you are agreeing to all the statements listed above,

including, but not limited to, release of liability and medical treatment.

Please Sign and Date:

_________________________________________ _______________

Parent/Guardian Signature Date

_________________________________________ _______________

Parent/Guardian Signature Date