YOUTH PARTICIPANT REGISTRATION FORM
SPORT Boys or Girls TeeBall
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).
All Participants please select shirt size:
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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.