mark@ntsasports.org
Name of Participant #1
Date of Birth
Name of Participant #2
Parent/Guardian Name
Full Address
NOTE: Required equipment will be provided to participants.
Dates, Times, & Locations:
Johnson City: Monday, February 29, 2016 6pm-7:30pm @ Indian Trail Intermediate Schooll 307 Car Mol Dr Johnson City, TN 37601
Bristol: Thursday, March 3, 2016 6pm-7:30pm @ Sullins Academy 22218 Sullins Academy Dr, Bristol, VA 24202
Kingsport: Saturday, March 5, 2016 10am-12pm @ Ross N Robinson Middle School 1517 Jessee St, Kingsport, TN 37664
Greeneville: Saturday, March 5, 2016 3pm-5pm @ Mosheim Elementary School 297 W. School St. Mosheim, TN 37818
Note: Experienced coaches will provide up to 1.5 hours of instruction on the fundamentals of lacrosse.
I authorize my child to participate in the Northeast Tennessee Sports Association Youth Street Hockey Program. Upon signing this form; I hereby release the Northeast Tennessee Sports Association, the City of JC, Johnson City Schools, Fairmont Elementary School, and any employees of these organizations, event sponsors, and all persons involved with the program from any and all responsibility of any injury(s) that my child may sustain while participating in a game or practice.
Electronic Signature
Today's Date
