Membership Form 2014-2015

Alameda Vipers Membership Form 2014-15

This form is for players who have completed the Tryout Process and have been accepted to a Vipers Team. If you would like to tryout, please submit an Alameda Vipers Tryout Waiver instead.

Head Coach *
Head Coach
Player Information
Player Name *
Player Name
DOB *
DOB
Parent1/Guardian1
Parent1/Guardian1 Name *
Parent1/Guardian1 Name
Has Custody *
Primary Phone *
Primary Phone
Work Phone
Work Phone
Home Phone
Home Phone
Parent2/Guardian2
Parent2/Guardian2 Name
Parent2/Guardian2 Name
Has Custody
Primary Phone
Primary Phone
Work Phone
Work Phone
Home Phone
Home Phone
Agreement and Verification
Terms and Conditions *
Have you read and agree with our Membership Terms and Conditions?

This document includes: Release and Waiver of Liability and Indemnity Agreement, Medical Release Information, General Information, Alameda Vipers Code of Conduct, Player Code of Conduct, Parent/Guardian Code of Conduct, Parent/Guardian Commitment and Photo Release.
To verify all the information above is correct and that you have read and agree with our terms and conditions, please type your full name.
To verify all the information above is correct and that you have read and agree with our terms and conditions, please type your full name.
Today's Date *
Today's Date