Athlete First Name *

Athlete Last Name *

Athlete Email *

Athlete Phone *

Athlete date of birth: *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980

Are you currently enrolled in Fall classes at GVSU? *
- Select Option Yes No

What will be your university class standings for the 2021-22 academic year? *
- Select Option Freshman Sophomore Junior Senior Not listed Please specify a value for What will be your university class standings for the 2021-22 academic year?

Primary position played: *
- Select Option Goalkeeper Right Full-back (or Wingback) Left Full-back (or Wingback) Center-back Center back (or sweeper) Defensive Midfielder Right Midfielder (or winger) Center Midfielder Center Forward (or Striker) Attacking Midfielder (or Center Forward) Left Midfielder (or Winger)

Highest level played: *
- Select Option Club team High School Not listed Please specify a value for Highest level played:

Previous School or Team: *

Emergency Contact Name *

Emergency Contact Phone *

Anything coaches or athletic trainers should be aware of (allergies, past injuries, etc.)?

I hereby declare, assert and affirm that my participation in Grand Valley State University Club Sports is done having voluntarily and knowingly assumed all risks involved in this program. The physical risk(s) associated are those correlated with normal, vigorous physical activity.  These risks include but are not limited to, bodily discomfort and fatigue, muscular soreness, pulled or strained muscles, overuse injuries/soft tissue damage, bodily injury resulting from falls, and the rare instance of abnormal changes/responses of the cardiopulmonary system to exercise.  Adverse responses include abnormal blood pressure, heart arrhythmias, and the very rare instance of heart attack, stroke, or sudden death.

In consideration of acceptance of this contract allowing my participation in Club Sports and intending to be legally bound thereby, I hereby for myself, my heirs, executors, administrators and assigns, WAIVE AND RELEASE any and all rights and claims for negligence, injuries, damages or losses that I may incur while involved in Club Sports, specifically Grand Valley State University, it’s respective employees, agents, representatives, successors and assigns for any and all activities connected with Club Sports.  If I am a Grand Valley employee, I also understand that I do hereby WAIVE any and all rights or benefits under the State of Michigan Worker's Compensation laws for any injury incurred as a result of my participation in this program. 

My signature below affirms that I have read and agree to all of the above content regarding my participation in the GVSU Club Sports Program, and that this Agreement is binding throughout my entire duration as a student at Grand Valley State University.