Washington County Recreation Department "Making Childhood Dreams Come True"

Home Current Programs Rec Department Rules Registration Forms Facility Rental Form Facility Usage Policies Map E-Mail Registration Forms CHILDS NAME ___________________________________ CHILD'S FULL NAME AS IT APPEARS ON HIS BIRTH CERTIFICATE:______________________________ LEAGUE YOUR CHILD IS PLAYING IN_______________________________ PHONE NUMBER (HOME)_______________(WORK)________________(E-MAIL) ____________________ DATE OF BIRTH___________________________________ CURRENT ADDRESS:_________________________________________ _________________________________________ PARENT/GUARDIAN'S NAME(S)_________________________________________________________ YOUR CHILDS PHYSICIAN_______________________________ LIST ANY MEDICATIONS THAT YOUR CHILD MAY BE ALLERGIC TO___________________________ THIS STATEMENT IS TO CERTIFY THAT THE CHILD LISTED ABOVE IS COVERED BY INSURANCE WITH THE ________________________________ COMPANY. I MAKE THIS WAIVER OF INSURANCE KNOWING THAT IT IS A REQUIREMENT OF THE WASHINGTON COUNTY RECREATION COMMISSION THAT ALL PARTICIPANTS IN CONTACT SPORTS HAVE MEDICAL INSURANCE. I FURTHER AGREE THAT IN THE EVENT THAT MY INSURANCE COVERING THE ABOVE NAMED CHILD IS CANCELED, NOT IN EFFECT, OR INSUFFICIENT TO COVER AN INJURY SUSTAINED, I DO RELEASE THE WASHINGTON COUNTY RECREATION COMMISSION FROM ANY AND ALL CLAIMS OR INJURIES SUSTAINED BY MY CHILD WHILE PARTICIPATING IN THE WASHINGTON COUNTY RECREATION ACTIVITIES. IN THE ABSENCE OF MY PRESENCE, I GIVE PERMISSION TO MEDICAL AUTHORITIES TO MEDICALLY TREAT MY CHILD, AS DEEMED NECESSARY. ______________________________________ SIGNATURE PLEASE CIRCLE SIZES YOUR CHILD WILL NEED FOR HIS/HER TEAM UNIFORM: FOR BASEBALL, SOFTBALL, BASKETBALL & FOOTBALL: IF PLAYING CONTACT FOOTBALL, MOVE UP (1) SIZE FROM WHAT YOU NORMALLY WEAR. YS (6-8) YM (10-12) YL (14-16) AS (34-36) AM (38-40) AL (42-44) AXL (46-48) AXXL (50-52) FOR SOCCER: SHORTS: XS (18-20) YS (20-22) YM (22-24) YL (24-26) AS (28-30) AM (32-34) AL (36-38) AXL (40-42) SHIRTS: YS (30-32) YM (32-34) YL (34-36) AS (36-38) AM (38-40) AL (40-42) AXL (44-46) SOCKS: U6 & U8 - SMALL U10 & U12 - MEDIUM U14 & U16 - LARGE Code of Conduct Please review the following items, sign the form and return it with your childs registration. The Washington County Recreation Department wishes to make each youth sport experience a positive one for every child participating. In reaching this goal, the following needs must be adhered to: I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice, or other youth sports event. I will place the emotional and physical well-being of my child ahead of a personal desire to win. I will support coaches and officials working with my child, in order to encourage a positive and enjoyable experience for all. I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol, and will refrain from their use at all youth sports events. I will remember that the game is for youth - not for adults. I will do my very best to make youth sports fun for my child. I will ask my child to treat other players, coaches, fans, and officials with respect regardless of race, sex, creed, or ability. _____________________________________ Parent's Signature __________________ Date Washington County Recreation Department 200 Franklin Haynes Drive P.O. Box 1115 Sandersville, Georgia 31082 Phone (478) 552-0013 Fax (478) 552-2014 "Making Childhood Dreams Come True" Sandersville, GA 31082 Phone: (478) 552-0013 P. O. Box 1115 Sandersville, GA 31082 Phone: (478) 552-0013