Providence, RI Learn to Play Clinic Registration
Register your child for our Learn to Play clinics here!

Remember to print and bring the Medical Authorization form to the clinic,
http://www.usaultimate.org/assets/1/Page/Medical%20Authorization-V4.1.form.pdf.

You will have a chance to consent to the USA Ultimate Waiver in the registration form, but you can also view and print out the waiver here, http://www.usaultimate.org/assets/1/Page/2017%20Waiver_11.30.16.pdf.

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What is the clinic participant's experience with ultimate? *
What is the clinic participant's first and last name? *
What is the participant's gender? *
What is the participant's date of birth? *
What is the participant's street address? *
What is the participant's city, state and zip code? *
What is the name of the school the clinic participant attends? *
What is the participant's approximate projected high school graduation date (month/year)? *
What is the parent or guardian's first and last name? *
What is the parent or guardian's phone number? *
What is the parent or guardian's email address? *
How did you hear about this Learn to Play Clinic? *
Please check all that apply.
Required
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to indemnify and hold harmless the releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs above, even if arising from their negligence, to the fullest extent permitted by law. *
Required
View USA Ultimate waiver by clicking on the below link.
http://www.usaultimate.org/assets/1/Page/2017%20Waiver_11.30.16.pdf
USA Ultimate Waiver
Remember to print and bring the USA Ultimate Medical Authorization form to the clinic.
http://www.usaultimate.org/assets/1/Page/Medical%20Authorization-V4.1.form.pdf
USA Ultimate Medical Authorization Form
Please make sure to bring this completed form to the clinic.
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