THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

YOUTH PARTICIPANT REGISTRATION FORM

Flag & Tackle Football

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:

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

*************************************************************************

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 LEAGUE DRAFT *****

Tackle Football will play a traveling schedule.

Parents responsible for transportation to and from games.