Parkland Youth Center Skills Registration Form

Parkland Youth Center Skills Registration Form

Parkland Youth Center Skills Registration Form

Parkland Youth Center Skills Registration Form

Last Name: ______First Name: ______MI: ___

Address: ______

Phone: ______Grade: ______

Parents Email: ______

Father’s name: ______Mother’s Name: ______

Registration Fee: $45

Mail form with check payable to PYC to: Mike Lahanas 2026 Sunrise Dr, A-Town 18104

Home 610-770-0423

Parental Consent Form

Parent/Guardian:

As legal guardian of the players(s) named on this registration form, I/we hereby grant my full consent & approval for my child (ren) to participate as a team member in any PYC organizational activities during the current season. This includes but is not limited to the following: practices, games, fundraising, and transportation to & from games, practices & other organizational events. By signing this document, I/we agree to abide by all the rules, regulations, & decisions of PYC & its respective sports leagues.

I/we, the undersigned, understand that there are certain risks of injury inherent in the practice & play of this sport, as well as, traveling & and other related activities incidental to my child(ren)’s participation. I am willing to assume these risks on behalf of my child. In addition to giving my full consent for my child (ren)’s participation, I/we do hereby release, waive, absolve, indemnify & and agree to hold harmless the PYC Organization, its respective sports leagues, the Parkland School District, their officers, coaches, sponsors, organizers, directors, supervisors, officials, members, participants, & persons transporting our children our child (ren) to & from PYC activities, from any responsibility or liability for any claim for damages which the player (s) listed on this registration form. This includes but is not limited to play, practice or activity associated with the PYC Organization or in traveling to or from the playing field, or place of activity at which any practice, game, exhibition or event may be conducted. We, the undersigned, assume all financial responsibility for payment of medical, dental expenses for the named player (s). The PYC organization assumes no liability or costs in the event of injury, death or illness of any kind, due to participation in the PYC activities. I hereby certify that my child is fully capable of participating in the designated sport & that my child is healthy & has no physical/mental disabilities or infirmities that would restrict full participation in these activities, except as listed below:

We herby intend to be legally bound and this agreement shall bind my/our heirs, administrators, executors and assigns.

Signature Date Relationship to Player