LAMAR COUNTY RECREATION DEPARTMENT REGISTRATION FORM
Participant’s Full Name: Age: Gender: Male Female
Address: City______Zip______
Birthdate: Sport Registering For: __SOCCER______Parent Interested in Coaching? Yes No
**Cell Phone # __ Medical condition that a coach should be aware of?
*Would you like for your child’s picture, if taken, to be used for advertisement such as Facebook or the Newspaper? Yes No
Uniform Size Top: YXS YS YM YL AS AM AL AXL A2XL OTHER: __
Uniform Size Bottom: YXS YS YM YL AS AM AL AXL A2XL OTHER:
WAIVER AND RELEASE OF LIABILITY
For and in consideration of the participation by me and my family, I hereby release, indemnify, and hold harmless LAMAR COUNTY, GEORGIA AND THE LAMAR COUNTY PARKS AND RECREATION DEPARTMENT, ANY AGENTS AND EMPLOYEES OF EITHER, from liability for injury, death, loss, or property damage which may be incurred by me, my family, and children while participating in any activities at any Lamar County Recreation Complex or Facility or in any activity sponsored by the Lamar County Parks and Recreation Department or engaging in any activities incidental thereto, whether past, present, or future, wherever or however the same may occur. On behalf of me and my family and children, I assume full responsibility for any and all injuries and damages which may occur to me or to them as a result of the above described activities. I, the parent/guardian of the above named child, hereby give my permission to the person in charge of the activity to take my child to the doctor/hospital in case of an emergency. I understand that I will be responsible for any and all costs incurred by emergency transportation or treatment provided.
MUST BE SIGNED BY PARENT/GUARDIAN
Parent or Guardian Name (Please Print): Parent or Guardian Email:
Signature: Date:
REGISTRATION FEE: PAID UNPAID PAYMENTS Comments/Request:
LAMAR COUNTY RECREATION DEPARTMENT REGISTRATION FORM
Participant’s Full Name: Age: Gender: Male Female
Address: City______Zip______
Birthdate: Sport Registering For: SOCCER ______Parent Interested in Coaching? Yes No
**Cell Phone # __ Medical condition that a coach should be aware of?
*Would you like for your child’s picture, if taken, to be used for advertisement such as Facebook or the Newspaper? Yes No
Uniform Size Top: YXS YS YM YL AS AM AL AXL A2XL OTHER: __
Uniform Size Bottom: YXS YS YM YL AS AM AL AXL A2XL OTHER:
WAIVER AND RELEASE OF LIABILITY
For and in consideration of the participation by me and my family, I hereby release, indemnify, and hold harmless LAMAR COUNTY, GEORGIA AND THE LAMAR COUNTY PARKS AND RECREATION DEPARTMENT, ANY AGENTS AND EMPLOYEES OF EITHER, from liability for injury, death, loss, or property damage which may be incurred by me, my family, and children while participating in any activities at any Lamar County Recreation Complex or Facility or in any activity sponsored by the Lamar County Parks and Recreation Department or engaging in any activities incidental thereto, whether past, present, or future, wherever or however the same may occur. On behalf of me and my family and children, I assume full responsibility for any and all injuries and damages which may occur to me or to them as a result of the above described activities. I, the parent/guardian of the above named child, hereby give my permission to the person in charge of the activity to take my child to the doctor/hospital in case of an emergency. I understand that I will be responsible for any and all costs incurred by emergency transportation or treatment provided.
MUST BE SIGNED BY PARENT/GUARDIAN
Parent or Guardian Name (Please Print): Parent or Guardian Email:
Signature: Date:
REGISTRATION FEE: PAID UNPAID PAYMENTS Comments/Request: