Student's Name *

First Name

Last Name

Student's Birthday: *

MM

DD

YYYY

Student's Grade Level: *

2nd

3rd

4th

5th

6th

7th

8th

Student's Shirt Size *

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Adult XXXL

Parent/Guardian's Name: *

First Name

Last Name

Parent/Guardian's Phone Number: *

(###)

###

####

Parent/Guardian's Email:

(###)

###

####

Emergency Contact: *

First Name

Last Name

Emergency Contact's Phone Number: *

(###)

###

####

Parent/Guardian Consent for Photographs and Internet Use: *

I give my consent to the Original Six Foundation and/or their partners to photograph my child and to use such pictures and/or stories in connection with any of their work without consideration of compensation of any kind, and I do release the Original Six Foundation and/or their partners from any claims whatsoever which may arise in said regards.

Yes

No

The following questions are optional and are tracked for data purposes only. *

Understood