HIGGINSVILLE PARKS AND RECREATION
T-BALL AND COACH PITCH
REGISTRATION FORM
2018
Participant Name ______
Sibling Information______
(if playing in the same division)
Grade_______Boy/Girl (circle one) T-Ball or Coach Pitch (circle one)
(2018/2019 School year)
Parent Name ______Email______
Please indicate if you would be interested in being a volunteer coach Yes/No
If you have indicated that you would coach, please provide shirt size: Adult S, M, L, XL, XXL
Address______
Telephone______
Emergency Contact/Telephone______
Participant T-Shirt Size Youth 6-8 10-12 14-16 Adult S M L XL XXL
I hereby give my permission for the named individual to participate in a Higginsville Parks and Recreation Department Program. I am aware that the Higginsville Parks and Recreation Department does not provide medical insurance for the program participants. I understand that participation in program activities can be dangerous and that injuries may result from such activities as a part of this program. Understanding the risks attendant to this activity, I agree that no claim or demand will be made against the Higginsville Parks and Recreation Department, the Higginsville Park Board, the City of Higginsville and/or their agents and/or employees in the event of an accident.
Signature______Date______
Note: Parent or guardian required to sign for minor child.
Make checks payable to Higginsville Parks and Recreation Department.
Payment is required with registration forms. Mail completed forms to: Higginsville
Parks and Recreation Department, P.O. Box 110, Higginsville, MO 64037 or drop it
off at Parks Office at the Community Building or drop off at City Hall no later than
May 4, 2018. For additional information contact the Park Office at 584-7313.
Higginsville Parks and Recreation Department, an Equal Opportunity Employer, does not discriminate on the basis of race, color, national origin, sex, disability, genetic information, or age in its programs and activities, and provides equal access to all groups