THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

YOUTH PARTICIPANT REGISTRATION FORM

Softball

 

 

Name ________________________________________________________________________

 

Mailing Address ____________________________________   City ______________________                                                            

 

Telephone ___________________________  Date of Birth _______________   Age _________                 

 

Male _____ Female ______  Grade ____________   School _____________________________                                

 

Team Played on Last Year________________________________________________________  

 

Parent's Name _________________________  Email Address: ___________________________                                                                      

 

Business Telephone: Father ________________________ Mother ________________________                                    

 

Home Telephone:  Father  _________________________ Mother ________________________                       

 

Doctor ________________________________________  Telephone  _____________________              

 

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

 

NO REFUND AFTER FIRST PRACTICE...

 

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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. ____________________