Shooting Sports Ayssp Student/athlete Participation Form
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4AYSSP Student/Athlete Participation Form
•
Complete each section, including the “Release and Waiver of Liability, Assumption of Risk, and Indemnity
Agreement.” Please print legibly or type on the PDF form fields.
•
Return the signed original to your team’s coach, to be forwarded to the AGFC AYSSP Coordinator.
•
Forms must be returned by February 1 of each year to be eligible for AYSSP Team Packages. Students/athletes
registering after February 1 will not be eligible for AYSSP Team Packages.
•
Forms will not be accepted after March 1.
Student Information
Student Name: _________________________________________________________________
First
MI
Last
Hunter Education Number: ______________________________________________________
Address: ________________________________________________________ AR __________
P.O. Box / Street
City
Zip
Cell Phone: __________________________ Home Phone: ____________________________
E-mail Address: ________________________________________________________________
Date of Birth: _____/_____/19__________ Sex: M______ F______ Race: ________________
Parent/Guardian Information
Parent/Guardians Name: ________________________________________________________
First
MI
Last
Cell Phone: __________________________ Home Phone: ____________________________
Insured: Y_____ N_____ If yes, name of insurance provider: __________________________
Team Information
Team Name: __________________________________________________________________
Coach Name: __________________________________________________________________
Gun Type: 12 g______ 20 g______ Grade: ________________ Division: Jr. _____ Sr. _____
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