THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

YOUTH PARTICIPANT REGISTRATION FORM

Flag & Tackle Cheerleading

Name _______________________________ Mailing Address ______________________________

City _____________________ Inside ____ Outside ____ City Limits

Phone ___________________ Date of Birth __________________ Age ____________

Male _____ Female _____ Grade _______ School _______________________________

Is this the participant’s first time in our Cheerleading Program? ___________

If no, team cheered from last year: ______________________________

If eligible, would you want to cheer on the same team this year? ______________

Do you have sibling(s) cheering? _____ If so, name of sibling _________________________

Do you have sibling(s) playing football? ________ If so, name of sibling: __________________

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).

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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. ______________

***** NO REFUNDS AFTER MEASUREMENT DAY *****

Tackle Cheerleaders will cheer for tackle teams that play traveling schedule.

Parents responsible for transportation to and from games.