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Parks Recreation YOUTH SPORTS REGISTRATION FORM Last Name First Name Birth date Sport Age as of Aug. 1 of this year SHIRT SIZE Grade Gender Male Female YS YM YL AS AM AL AXL AXXL Address Mom s Name Dad s Name Mom s Cell Phone Dad s Cell Phone Mom s Alt. Phone Dad s Alt. Phone Mom s email Dad s email Please provide information about any allergies or medical conditions that the coach should have in case of emergency. Does your child have any current conditions that limit his/her ability to participate in this activity Yes No If yes please explain and identify any modification that would enable your child to participate. PARENTAL RELEASE AND HOLD HARMLESS AGREEMENT I understand that team members are expected to attend practices obey team rules of coaches and obey rules of the Parks and Recreation Department. I as a parent pledge to demonstrate good sportsmanship and agree to abide by all Parks Recreation rules and regulations. Those failing to do so will forfeit their uniform registration fee and position on the team* I/we the parent s /guardian s of the above named player understand there are inherent risks involved with sports participation and do hereby give permission for him/her to participate in any and all league activities during the named program* In consideration of the acceptance of the above entry as a member of the program conducted by the Nevada Parks and Recreation Department I do hereby waive release and forever discharge any and all rights and claims for damages which may hereafter accrue to me against the Parks and Recreation Department of the City of Nevada and their representatives or successors and/or arising out of travel to and return from said activities conducted through the year. I/We grant full permission to use any photographs videotapes recording or any other record of this program for any purpose. Signature of parent/guardian Date Volunteer Coach/Sponsor Sign Up FORMS SHOULD BE RETURNED TO In order to have a successful program for Nevada s youth we need for parents to be coaches and assistant coaches. Please circle if you are interested in coaching. NEVADA COMMUNITY CENTER 200 N* Ash Nevada MO 64772 COACH ASSISTANT COACH PHONE 417-448-2740 ---- FOR OFFICE USE ONLY ---- Registration Fee Paid Balance Due Method of Payment Check Cash Received By. 1 of this year SHIRT SIZE Grade Gender Male Female YS YM YL AS AM AL AXL AXXL Address Mom s Name Dad s Name Mom s Cell Phone Dad s Cell Phone Mom s Alt. Phone Dad s Alt. Phone Mom s email Dad s email Please provide information about any allergies or medical conditions that the coach should have in case of emergency. Phone Dad s Alt. Phone Mom s email Dad s email Please provide information about any allergies or medical conditions that the coach should have in case of emergency. Does your child have any current conditions that limit his/her ability to participate in this activity Yes No If yes please explain and identify any modification that would enable your child to participate.

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