Hillside Connection Registration Form
Please read all the information below and fill out this form for your participating child.
Parent First Name
Parent Last Name
Parent Email
Parent Phone Number
Address:
Street Address
City
State
Zip
Participant First Name
Participant Last Name
Participant Birthdate (
format example 10/1/2001
)
Participant Gender
Male
Female
Participant Ethnicity
African American/Black
Alaskan Native/American Indian Native
Asian
Bi-racial
Caucasian
Hispanic/Latino
Prefer Not to Say
Current Grade
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade - High School Freshman
10th Grade - High School Sophomore
11th Grade - High School Junior
12th Grade - High School Senior
Please Select Participant's Current School (type in school name, then select)
Please select Participant's Current School District (type in school district, then select)
Anticipated High School Graduation Date
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
Please select your shirt type
Youth
Adult
Please select your shirt size
Small
Medium
Large
Extra Large
2XL
How did you hear about Hillside Connection?
Word of Mouth
Social Media
Website
Radio or TV ad
Newspaper ad
Other
Has Participant attended a previous Hillside Connection event?
Yes
No
Programming Options:
Sports Development - Includes all Sports activities at Hillside Connection
Enrichment - Includes all non-Sports related activities at Hillside Connection
Choose the Programming your child wants to participate in:
Choose the Program your child wants to participate in:
About your Personal Information
The information you provide here will be processed solely for the purpose of registering your participant for a Hillside Connection Program.
WAIVER OF LIABILITY AND RELEASE OF ALL CLAIMS
By clicking on the agree button, I recognize and acknowledge that there are certain risks of physical injury to participants in a program, and I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims I or my child/ward may have as a result of participating in the program against the HILLSIDE CONNECTION Program and its officers, agents, servants and employees. I agree with HILLISIDE CONNECTION and affiliated partners to taking images or videos of my child participating in program activities for social media and/or news purposes.
Authorization/Consent for Treatment of Minor:
In the event of any emergency, I authorize the Event Staff to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child/ward's immediate care. I understand the Event Staff are not responsible for paying for any services rendered by any medical professional or medical facility, or for the cost of transportation to or from any medical professional or medical facility and agree that I will be responsible for payment of any and all medical services rendered.
By checking the agree box, you have read and fully understand the above event details, Waiver and Release of All Claims and Permission to Secure Treatment. I understand this authorization is given in advance of any specific illness, accident, injury or medical emergency. This authorization is given pursuant to the provisions of the laws of the State of Colorado and shall remain in effect one year from today's date unless withdrawn or revoked prior to that date. Any withdrawal or revocation of this authorization shall be in writing and delivered to Hillside Connection.
I agree
Text Messaging and Email Options
By checking the box below, you agree to receive text messages and emails from Hillside Connection. At anytime, you can opt out of receiving these notifications by emailing info@hillsideconnection.org.
Hillside Connection does not share SMS opt-in consent with any third-party organizations. Data and Message rates may apply.
Please click the I agree checkbox
I agree
Please add your social media link
Please add your social media link 1
If you would like to make a donation toward the cost of programming at Hillside Connection, click on
this link
to make a donation!
Please hit the submit button below to register your participant. Thank you.
Program ID
Benefit ID
Contact Information