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Athlete Information 2013
Last Name
First Name
Birth Date
Emergency Contact
List any medical conditions or special information
Parent Information
First Name
Last Name
Cell Number
Email Address
TERMS & CONDITIONS OF ENROLLMENT (Waiver Form): In consideration of being allowed to compete, officiate, observe or
participate in any way in CB Sports Club and; any of its affiliate athletic sports program, related events and activities, the
undersigned acknowledges, appreciates and agrees that:
1. I hereby certify that my child is in good health and capable of safe participation in this CB Sports Club program. I assume
all risk(s) and hazards incidental to the participation in this program and for the transportation to and from the program. If
however, I observe any unusual significant hazard during my presence and/or participation, I will remove myself/child from
participation and bring such to the attention of the nearest official immediately. I hereby authorize CB Sports Club to obtain
medical treatment for my child in the event that parent/guardian and the emergency contact cannot be reached. No refunds
will be granted after the start of the season except under extenuating circumstances subject to approval by the director of CB
Sports Club.
2. During the course of CB Sports Club programs, photographs are occasionally taken. Through this release, I authorize CB
Sports Club to print, publish, and display pictures of my child to promote CB Sports Club programs through CB Sports Club
publications and the CB Sports Club website, www.cbsportsclub.com .
3. As a parent, I promise to conduct myself in accordance to the CB Sports Club values and mission at all times. I will strive to
convey the importance of teamwork, cooperation, respect and sportsmanship while stressing participation and fun to my child
and will abide by the league’s rules and guidelines.  
4. In accordance with the CB Sports Club code of conduct, both my child and I understand that no foul language is permitted;
no fighting or threat of assault is permitted; and there shall be no derogatory comments directed toward any participant or
official that could be interpreted as degrading or would induce feelings of lesser worth. We both understand that if we do not
conduct ourselves according to this code of conduct or act in any other manner detrimental to the success or welfare of the
program, we shall be subject to immediate suspension, expulsion and/or other sanction deemed appropriate by the league’s
5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless
CB Sports Club, Club, Palmetto Bay Park, Village of Palmetto Bay, Town of Cutler Bay and  their officers, officials, agents,
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and owners and lessors of premises with
respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of
the releasees or otherwise.
Your signature below indicates that you have read, understood and agree to adhere to the league’s Rules; Regulations AND
Release of Liability Waiver. (This is available on the CB Sports Club website You must be 18 yrs or older to sign this waver).
Signature of Parent/Guardian