Become a Member

Youth Information

Youth First Name *

Youth Last Name *

Date of Birth *

Age *

School Name

Grade Level

T-Shirt Size

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email Address *

Phone Number *

Home Address *

City *

State *

ZIP Code *

Emergency Contact Information

Emergency Contact Name *

Relationship to Youth *

Emergency Contact Phone *

Emergency Contact Email

Medical Information

Primary Care Physician

Physician Phone Number

Insurance Provider

Known Allergies or Medical Conditions

Special Dietary Needs or Restrictions

Liability Waiver & Release

ASSUMPTION OF RISK, WAIVER OF CLAIMS & INDEMNIFICATION AGREEMENT

I understand that participation in Leigha's Girls programs and activities involves inherent risks including, but not limited to, physical injury, property damage, or other harm. I voluntarily assume all risks associated with my child's participation.

I hereby release, waive, discharge, and covenant not to sue Leigha's Girls, its officers, employees, volunteers, and agents from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by my child while participating in programs or activities.

I agree to indemnify and hold harmless Leigha's Girls from any loss or damage arising from my child's participation in programs or activities.

This agreement shall be binding upon my heirs, executors, administrators, and assigns. I have read this agreement and understand its terms.

Parental Consent & Digital Signature

Parent/Guardian Full Name *

Date *

I acknowledge that I have read, understood, and agree to the terms of the liability waiver and release above. By typing my name and submitting this form, I am providing my digital signature and consent for my child to participate in Leigha's Girls programs and activities. *

I give permission for my child to be photographed or recorded during Leigha's Girls activities for promotional and educational purposes.

I consent to receive communications from Leigha's Girls regarding programs, events, and important updates via email, phone, or text message.

Item added to your cart

Upcoming Events

Community Gathering

Leigha's Girls Youth Membership Application