THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

                    YOUTH PARTICIPANT REGISTRATION FORM

                                               ­­­DIXIE BASEBALL

 

 

Name ________________________________________________

 

Mailing Address_________________________________________

 

City _____________________   Inside ____   Outside ____  City Limits

 

Phone ___________________   Date of Birth __________________    Age ____________

 

Male _____  Female _____ Grade _______  School _______________________________ 

 

Parent's Name _____________________________________________________________

 

Email Address:  ________________________________Last Year’s Team  ______________

 

Business Phone_______________________________  

 

Father __________________________      Mother _________________________

 

Home Phone  Father __________________________    Mother _____________________________ 

 

Doctor ______________________________________  Phone  _____________________________

 

Child's Physical Condition _____________________________________________________                                                                                   

(List any physical or mental handicaps or diseases such as epilepsy, heart murmur, rheumatic fever, etc.

 which your child may have or any other special medical information which may affect your child's participation).

 

.........NO REFUNDS AFTER FIRST PRACTICE................

 

All Participants please select shirt size:

Please select SHIRT SIZE:     YS   YM   YL       AS   AM   AL   AXL   A2X

 

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The Thomaston-Upson Recreation Department would like to notify parents/guardians that photos of individual players or teams will be

 taken for our sponsors and promotional projects.

 

I/We, the above parents of the above named child, hereby give my/our approval for their participation in activities during the current season.

 I/We assume all risks and hazards incidental to the conduct of the activities and transportation to and from activities.

 I/We do further hereby release, absolve, indemnify and hold harmless the Thomaston-Upson County Recreation Commission,

 Recreation & Parks Department, the organizers of the activity, sponsors, supervisors any or all of them.  In case of injury to my/our child,

 I/We hereby waive all claims against the organizers, the sponsors, or any of the supervisors appointed by them except to the extent covered by insurance.

 I/We do certify that our ward is covered by group accident or other comparable insurance.

 

I/We, the parents of the above named child, hereby give my/our permission to the person in charge of the activity to take my/our child to the

 doctor or hospital in case of injury.  I/We understand I/We will be responsible for any and all cost incurred by emergency transportation or medical

 treatment provided.

PARENT'S SIGNATURE                                                        DATE                     RECEIPT NO. ____________________