Veteran Member Interest Form

If you are current or former member that needs assistance with your membership, please email veterans@blazesports.org. Do not fill out this form.

New veterans, after you complete this form, you will be contacted to complete your mandatory assessment. This form is not a confirmation of membership. Only after you complete your assessment will you have an active membership.

Your Contact Information

First Name *

Last Name *

Email *

Gender

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Emergency Contact *

Emergency Contact Phone *

Emergency Contact Email

Do you have a physical disability or a mental health diagnosis? * The field Do you have a physical disability or a mental health diagnosis? is required.

If you have physical disabilities, including injuries, please list below: * The field If you have physical disabilities, including injuries, please list below: is required.

Do you have any of the following mental health diagnosis? Please select those that apply * The field Do you have any of the following mental health diagnosis? Please select those that apply is required.

If your diagnosis was not listed above, please list here. The maximum length for the field If your diagnosis was not listed above, please list here. is 500 characters.

T-shirt Size * The field T-shirt Size is required.

Which Branch of Military did you serve in? * The field Which Branch of Military did you serve in? is required.

How did you hear about BlazeSports? * The field How did you hear about BlazeSports? is required.

BlazeSports Waiver

The undersigned acknowledges and agrees as follows:

I hereby agree not to sue and release, hold harmless, and forever discharge, BlazeSports America, Inc. any co-sponsoring entities of the Programs, all of their officers, directors, members, agents, and/or employees, and any and all sponsors, officials, volunteers, and other participants of the BlazeSports Programs/Events (collectively, the “Releasees”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, property damage, or personal injury, including death, that may be sustained by me or any property belonging to me, whether arising from negligence of any of the Releasees, or otherwise, while participating, including transportation to and from said programs. I hereby consent to the administration of first aid or other medical treatment if needed during the program. I agree to assume full responsibility for payment of any and all fees incurred as a result of such medical treatment. I understand that all participants in this program/event are required to have their own medical insurance coverage, and that neither BlazeSports America, Inc. or any other sponsoring entities provide such coverage.

I hereby voluntarily and without compensation authorize visual images and/or voice recordings to be made of me by or on behalf of BlazeSports America, Inc. and other sponsoring entities during the Programs. I also authorize the foregoing entities and their assigns to reproduce, modify, publicize, broadcast and display any such visual.

This covenant not to sue, release and hold harmless agreement is binding on me, my heirs, assigns, personal representatives, administrators, and next of kin.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.

By registering, you also agree to receive emails from BlazeSports America.

Please enter your first and last name to agree to the waiver: * The field Please enter your first and last name to agree to the waiver: is required.