Youth Program Registration

Participant *
Participant
Address *
Address
Date of Birth:
Date of Birth:
Program *
Team Sports Shirt Size
Youth Sports
1st Contact
1st Parent’s Name *
1st Parent’s Name
1st Parent's phone *
1st Parent's phone
2nd Contact
2nd Parent’s Name:
2nd Parent’s Name:
2nd Parent's phone
2nd Parent's phone
Emergency Contact
Emergency Contact *
Emergency Contact
Emergency Phone *
Emergency Phone
Medical Information
Physicians Name *
Physicians Name
Physicians Phone *
Physicians Phone
Liability Waiver
Further, I authorize the Guilford Recreation and it’s volunteers to provide emergency treatment of any injury or illness my child may experience, if qualified medical personnel consider the treatment necessary, and perform the treatment. This authorization is granted only if I cannot be reached, and a reasonable effort has been made to do so, or a life threatening situation is at hand. My child and I are aware that participating in this recreation activity may be potentially hazardous. I assume all risks associated with the participation in this program including, but not limited to, falls, contact with other participants, the effects of weather, traffic, and other reasonable conditions associated with the program. All such risks to my child are known and appreciated by me. I understand this consent form and agree to its conditions on behalf of my child.
Checkbox *
Today's Date: *
Today's Date: