Sport & Health Inter-club Varsity League
4400 Montgomery Avenue, Bethesda, MD 20814
 

_____________________________ ____ ____ __________ __________  
Name of Student Sex Age DOB  School
 
______________________________
Name of Parent/Guardian
 
Address:
________________________________________________________________________
Street City State Zip
 
Telephone:
(____)_______________ (____)_________________ (____)______________________ 
Home  Father’s Work     Mother’s Work
 
Email:
_______________________ ________________________
Student Parent
 
Does your child have any medical problems?_____ If yes, please describe._________________
 

 
 
RELEASE: In consideration of making facilities and services available, I do hereby for and on behalf of
myself and my heirs and legal representatives, release and forever discharge Sport and Health, its owners,
manager and representatives from any and all claims and demands of every kind, nature and character which
I may have or may hereafter acquire for any or all damages or losses which may be suffered or sustained by
me in connection with my activity and all such claims are hereby waived and released

X______________________________ Parent or Guardian Signature (Required