Morehead City Parks and Recreation Department

Athletic Program Registration Form
PRINTABLE FORM

City Residents Registration Fee: $20.00

Non-City Residents Registration Fee: $25.00

   Child�s Name: _____________________________________________________________________________

		            Last			First			Middle			Name Preference

   Parent�s/Guardian�s Name: ___________________________________________________________________

   Phone Number:	Home: ________________________		Work: ______________________________

   Street Address: _____________________________________________________________________________

   Mailing Address: ___________________________________________________________________________

   Child�s Age: __________	Child�s Date of Birth: ___________		Child�s Gender:     male        female

   Program: (Please Circle)        	Basketball		T-Ball		Coach-Pitch Baseball

   Previous Year�s Team Placement: ___________________	Desired Team Placement: ____________________

Release of Liability

 	I do hereby and forever discharge the participants, instructors, and administrators of the Morehead City Parks and Recreation Department from any and all actions, claims, and demands for or by reason of any damage, loss or injury which hereafter may be sustained by me or my child in consequence of participation by said person in this program.

 	I hereby acknowledge and admit that the Morehead City Parks and Recreation Department shall not be required to carry any insurance protection for the participants and thereby do agree to provide individual insurance coverage for myself and child.

 	Permission is hereby granted for my child ___________________________ to participate in the Morehead City Parks and Recreation Department�s program.

 	_____________________________________________________________________

 	Parent/Guardian Signature                                 Date

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For Office Use Only

      Fee:______________            Date Paid:________________________



      Cash:_____________            Received Initials:________________



      Check:____________            Group:     Boys       Girls       Coed

	     Age:  5- 6    7-8    9-10    11-12    13-14    15-16    17-18