Thank you! We Received Your Waiver Submission
Valid for 2021, No Need to Complete Additional Entries until 2022

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Player Name: {Player\’s Name (First):1.3} {Player\’s Name (Last):1.6}
Player Date of Birth: {Player\’s Date of Birth:2}
Parent Name (If Applicable): {Parent or Guardian\’s Name (If under age 18) (First):5.3} {Parent or Guardian\’s Name (If under age 18) (Last):5.6}
Player Phone: {Player\’s Phone:9}
Emergency Contact: {Emergency Contact Name:7}  Phone: {Primary Emergency Phone:52}
Emergency Contact: {Contact 2:51}  Phone: {Contact 2:53}
Date Completed: {date_mdy}
Player ID: {entry_id}