2. Which Sports Clinic Are You Registering For?*

   1. Youth Boys Basketball
   2. Youth Boys Baseball
   3. Youth Girls Basketball
   4. Youth Girls Softball
   5. Youth Football
4. Student Information
6. Student Last Name*
7. Student Middle Name
8. Student First Name*
10. Birth Date*
11. AGE
12. Which Caddo Parish High School are you representing?
14. Address*
15. Apartment Number
17. City
18. State*
19. Zip Code*
21. In Case of Emergency Call
23. Emergency Contact Name*
25. Emergency Contact Phone*
27. Emergency Contact Relationship to Student*
29. Medical Information
31. Illness/Allergies
33. Medications
35. Special conditions/concerns:
37. Parental/Guardian Permission and Waiver
39. By my signature below, I, the parent or guardians of the above-named participant, give my permission for him/her to participate with Shreveport Public Assembly & Recreation (SPAR). I hereby swear and attest that the above-named child is physically fit and has no medical reasons which would prevent him/her from safely participating in the current SPAR. Furthermore, I hereby acknowledge that it is my responsibility to inform my child’s coach or SPAR Athletic Division staff, in writing, if there is any change in the medical condition of my child. I also understand that it’s my responsibility to obtain written permission from my child’s physician on official medical stationary in order to seek permission for my child to resume participation after any and all such injury, illness or accident.
    
    I acknowledge that I am fully aware of the potential dangers of participating in any sport and I fully understand that participating may result in any injuries, paralysis, permanent disability and/or death. Therefore, I do hereby, for the above-named participant, agree to indemnify, defend and hold harmless the City of Shreveport, its elected officers, employees, sponsors and agents against any and all claims, demands, suits, damages and expenses that may arise out of or in connection with the purposes stated herein. I also agree to provide a certified birth certificate of the above-name which will be kept on file at the SPAR Athletic Office.
41. Waiver of Liability Release Form
43. I hereby agree to indemnify, release, defend, and hold SPAR and the City of Shreveport, and all of its members, officers, agents and employees, both paid and voluntary, hereinafter referred to as “RELEASEES”, harmless of and from any and all liability, claims, suits, or cause(s) of action which may arise, regardless of whether caused by the negligence of RELEASEES, from bodily injury, death or property damage, to me, or my children, or to third persons as a result of my, or my child’s, participation in the activities. I have been fully advised to the terms of the event and hereby agree to perform and consent to my participation, as well as my child’s participation, in the activities. I release RELEASEES from any claim whatsoever on account of first aid, treatment, or service rendered to me or my children during participation in the activities. I give SPAR and the City of Shreveport permission to photograph my child or myself for the purpose of publicizing events and/or programs. The terms of this release are contractual and not a mere recital.
45. 1. Agree to all
47. Parent or Guardian Signature*
49. Date*
51. Parent Email Address*
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field