ATHLOGNOSIA // Application Form


Fill Application Form for one player or for one team

Event :
Dates / Session :

Name :
Father's name :
Street Address :
Postal Code :
City :
Country :
Home telephone :
Email :
Date of birth :

Name of current team :
Category :
City :
Division :
Height :
Weight :
Points / Game :
Rebounds / Game. :
Assists / Game :
Steals / Game:
Coach's name :
Coach's telephone :

Submit
I, the undersigned, submit my son is physically fit to participate in strenuous athletic activity, and waive Athlognosia of any and all responsibility or injury or illness. I hereby authorize the directors of Atlognosia to act for me according to their best judgement in any emergency requiring medical attention. I also understand that I am solely responsible for the payment of any such medical expenses. I also understand that my payments are non-refundable, non-transferable under any circumstances.