THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

                    YOUTH PARTICIPANT REGISTRATION FORM

                                     Fall Baseball                    

 

 

Name _______________________________  Mailing Address ____________________________________                               

City _____________________   Inside ____   Outside ____  City Limits

 

Phone _____________________________________   Date of Birth __________________    Age                  

 

Male _____  Female _____ Grade _______  School ______________________________________                                

 

Team Played on Last Year __________________________________ 

 

Parent's Name ___________________________   Email Address _______________________________                                                                     

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 REFUND 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. ________________