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Eudora Parks and Recreation Program/Sports Registration Form
www.eudorapr.org |
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Player/Participant Information |
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Last Name: _________________________________ First Name: __________________________________ Address:_________________________ City:_______________________ Zip Code: _______ Phone: _________ School:______________ Grade:_____ Date of Birth:___/___/_____ Age:________ Gender: M F (month/day/year) |
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SHIRT SIZE: (Circle correct size) Shirt: 6-8 10-12 14-16 AS AM AL AXL AXXL XXXL |
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Parent Information |
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Father’s Name: ___________________ Home Phone:___________________ Cell:____________ Mother’s Name: ___________________ Home Phone:___________________ Cell:____________ E-Mail: (IMPORTANT) ____________________________________________ ALTERNATE EMERGENCY CONTACT:________________________________________ Phone:____________
Parents, Eudora Recreation needs you! If possible, please check where you might be able to assist in any area. ___ Coaching ___ Assistant Coach ___ Team “Mom” ___ Team Sponsorship ___ Official/Referee |
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Parental Consent and Waiver — (If under 18) |
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I give permission for my child, named above, to participate in EP&R Programs or Sports. To the best of my knowledge, my child, named above, is medically and physically fit to participate. I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of EP&R, along with its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with any sport and in consideration of EP&R accepting the registrant for its activities, I hereby release, discharge, and/or indemnify EP&R, and its affiliated organizations and sponsors, their employees and associated personnel including the owners of fields and facilities utilized for the sport or program, against any claim by or on the behalf of the registrant’s participation and/or being transported to or from the same, which transportation I hereby authorize. I furthermore want to be registered by EP&R Recreational Programs and pay fees now in full.
Parent/Guardian:______________________ Signature:___________________________ Date:__________ (Print Name) |
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Please return completed form and payment to: Eudora Parks and Recreation, 1630 Elm St., Eudora, KS 66025 Make checks payable to Eudora Parks and Recreation |
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OFFICE USE ONLY: Received by:_________________________ Date:_____________ Age Group: ______________ Amount paid:________________ Cash ____ Check # _______ |
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Program or Sport registering for: _____________________________________________________________________ |
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Team Registration Area — (for adult teams and programs)
Manager: _____________________ Phone: ______________________ Email: _________________________
Team Members: __________________________________ ____________________________________________ __________________________________ ____________________________________________ __________________________________ ____________________________________________ __________________________________ ____________________________________________ __________________________________ ____________________________________________ __________________________________ ____________________________________________ |
