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THOMASTON-UPSON COUNTY RECREATION & PARKS DEPARTMENT

YOUTH PARTICIPANT REGISTRATION FORM

Flag & Tackle Football

Name _______________________________ Mailing Address ______________________________

City _____________________ Upson County Resident

YES or NO

Phone ___________________ Date of Birth __________________ Age ____________

Male _____ Female _____ Grade _______ School _______________________________

Team Played on Last Year ___________________________________________________

Parent's Name ___________________________ Email Address ___________________________

Business Phone Father __________________________

Mother _________________________

Home Phone Father __________________________ Mother _____________________________

Doctor ______________________________________ Phone _____________________________

Child's Physical Condition _____________________________________________________

(List any physical or mental handicaps or diseases such as epilepsy, heart murmur, rheumatic fever, etc. which your child

may have or any other special medical information which may affect your child's participation).

All Participants please select shirt size:

Please select SHIRT SIZE:

YS YM YL

AS AM AL AXL A2X

*************************************************************************

The Thomaston-Upson Recreation Department would like to notify parents/guardians that photos of individual players or

teams will be taken for our sponsors and promotional projects.

I/We, the above parents of the above named child, hereby give my/our approval for their participation in activities during

the current season. I/We assume all risks and hazards incidental to the conduct of the activities and transportation to and

from activities. I/We do further hereby release, absolve, indemnify and hold harmless the Thomaston-Upson County

Recreation Commission, Recreation & Parks Department, the organizers of the activity, sponsors, supervisors any or all of

them. In case of injury to my/our child, I/We hereby waive all claims against the organizers, the sponsors, or any of the

supervisors appointed by them except to the extent covered by insurance. I/We do certify that our ward is covered by group

accident or other comparable insurance.

I/We, the parents of the above named child, hereby give my/our permission to the person in charge of the activity to take

my/our child to the doctor or hospital in case of injury. I/We understand I/We will be responsible for any and all cost

incurred by emergency transportation or medical treatment provided.

PARENT'S SIGNATURE

DATE

RECEIPT NO. ______________

***** NO REFUNDS AFTER LEAGUE DRAFT *****

TACKLE FOOTBALL

will play a traveling schedule.

Parents responsible for transportation to and from games.

Parents responsible for All Star transportation if selected.

Flag & Tackle Football Youth Participant Registration Form - Thomaston-Upson County Recreation & Parks Department