top of page

Step 2:  Player & Medical Information & Release
 

Enter Player Information followed by Medical Information. 
Sign the Release at the bottom of page and click 
SUBMIT
to enter payment or add another player.  

Select Team Level:
Select Shirt Size
Jersey Size:
Shorts Size:

Medical Information and Release

Please list TWO emergency contacts:

Cormorant Garamond is a classic font with a modern twist. It's easy to read on screens of every shape and size, and perfect for long blocks of text.

Emergency Authorization:  I hereby give permission for my above-named minor child to receive medical and/or emergency surgical treatment and/or transport.  Non-emergency medical tretament or elective surgery is not included in this authorization.  We understand that East Michigan Panthers is a volunteer program and will not hold the organization or any organization volunteers responsbile for injuries that may occur while participating in East Michigan Panthers activities. 

Agreement:  I have read the above emergency authorization and the homeschooling criteria and fully understand the terms of each.  By signing this, I agree to these terms, and I do so freely and voluntarily and without inducement for myself and on behalf of the above-named player.  I certify that the information I have provided above is true and correct to the best of my knowledge. 

Hold Harmless Agreement:  The undersigned agrees that he/she will indemnify and hold free and harmless East michigan Panthers, Howell, MI its administration, staff, governing board, directors, officers, agents, and coaches from any and all claims or actions for personal injury, sickness or disease, including personal injury suffered by the player named above, if caused by the acts or omissions of East Michigan Panthers, Howell, MI, its administration, staff, governing board, directors, officers, agents, and coaches, and the undersigned will pay any and all judgment, decrees, costs, including attorney fees, which may be rendered against East Michigan Panthers, Howell, MI, its administration, staff, governing board, directors, officers, agents, and coaches, in any and all such actions or proceedings.  

bottom of page