Thomaston-Upson County Recreation & Parks Department
Sport: Cheerleading
City_________________________________Inside_______
Outside______ City Limits
Phone
_______________ Date of Birth__________ Age__________________________
Male_____Female_____Grade
_______ School_________________________________
Do
you have sibling(s) playing football? ______
If so, name of sibling? _____________
Parent’s
Name____________________________________________________________
E-mail
Address___________________________________________________________
Business
Phone: Father__________________
Mother__________________________
Home
Phone: Father____________________
Mother__________________________
Child’s
Physical Condition
___________________________________________
(List any physical or mental handicaps of 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...
***************************************************************
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.________________