2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Participant is the same as above

   1. Yes
10. Participant First Name
11. Participant Last Name
13. Address1
15. City
16. State
17. Zip
19. Gender*

    1. Male
    2. Female
20. Participant Grade*
21. Jersey Size
    -- Select One --Youth MediumYouth LargeYouth XLargeAdult SmallAdult MediumAdult LargeAdult XLargeOther: Contact Katie
23. Emergency Contact #1 Name and Phone*
25. Emergency Contact #2 Name and Phone
27. Link to Parent and Athlete Code of Conduct
    Athlete and Parent Code of Conduct

    Please print, read and sign.  To be turned into the coach by the 1st game.

29. Waiver

    While we realize that the Village of River Grove will take every possible safety precaution in the performance and operation of the above event or program, we the undersigned, adult or parent/guardian, acknowledge the  Village of River Grove, its employees, supervisors, and representatives cannot be held liable for any accidental injury or illness.  In cases of minors, you give your consent for emergency care to be called for and administered if those situations should arise.  PHOTO POLICY: The Village of River Grove periodically takes photographs or videos during a class, game, event, or at facilities or parks.  I grant full permission to the VIllage to use my name, photograph, video, or recording for any publicity promotion without obligation or liability.

31. Parent/Guardian Signature
32. Date
    Date
34. Registration Fee*
    -- Select One --Non-Resident - $125.00Resident - $110.00
35. Cost of Activity
Leave This Blank:


41. Calculate Totals Proceed to Checkout

* indicates a required field