St. Mary'S County Department Of Recreation And Parks Leonardhall Team Registration Form

Download a blank fillable St. Mary'S County Department Of Recreation And Parks Leonardhall Team Registration Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete St. Mary'S County Department Of Recreation And Parks Leonardhall Team Registration Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

St. Mary's County Department of Recreation and Parks

Leonardhall Team Registration Form

23150 Leonard Hall Dr. P.O. BOX 653

Leonardtown, MD 20650

(301) 475-4200 *1830

LEAGUE: _____________________________________ TEAM NAME: ___________________________________ DIVISION: ________ CODE: ________________

COACH NAME: ________________________________ ASSIST.COACH: ___________________________ COACH HOME PHONE #: ________________________

EMAIL ADDRESS: _____________________________________________________________________ COACH CELL PHONE #: ____________________________

COACH ADDRESS: __________________________________________ CITY: _______________________________ STATE: ________ ZIPCODE: _______________

AMOUNT: $ _____________

CHECK NUMBER: _____________

MONEY ORDER NUMBER: _____________

CASH AMOUNT: $ _____________

PLAYER'S NAME

ADDRESS

PHONE #

D.O. B

ADULT SIGNATURE ***

*** BY SIGNING THIS FORM YOU ARE AWARE OF THE INDEMNIFICATION STATEMENT BELOW; MINORS MUST HAVE A PARENT/GUARDIAN SIGNATURE

Release and Waiver of all Claims: The Undersigned participant (Parent/Guardian) understands that this release forever discharges and holds harmless, St. Mary’s County Government/Department of

Recreation and Parks from any liability or claim that participant may have against St. Mary’s County Government with respect to any bodily injury, personal injury, illness, death, property loss or damage that

may result from participant’s activities, whether caused by the negligence of St. Mary’s County Government/Department of Recreation and Parks or its officers, directors, employees, agents, volunteers or

otherwise. Participant (Parent/Guardian) also understands there are inherent physical risks associated with activities and programs and that, St. Mary’s County Government does not carry or maintain health,

medical, or disability insurance coverage for any participant. Each participant is expected and encouraged to obtain his or her own medical or health insurance coverage.

I also authorize the Commissioners of St. Mary’s County (including its departments, boards, commissions, agents, employees and volunteers when authorized by the Commissioners of St. Mary's County or by

the Director of Recreation and Parks) to use my image and/or voice in any media form (including, but not limited to, cable television broadcasts, videos, internet communications, and publications). I release

the Commissioners of St. Mary’s County from any and all claims and liability regarding the making or use of an audio and/or visual recording of my image and/or voice (including claims related to rights of

publicity or privacy, defamation, or portrayal in a false light, whether intentional or unintentional).

Do you or does the participant have any special need that requires accommodations? Yes ___ No ___ (If, Yes please provide details below) _________________________________

Coach Signature: ______________________________________ Print Name: _______________________________________________________ Date: __________________