Council Registration Form

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FALLSTON RECREATION COUNCIL Registration Form
TO BE COMPLETED BY REGISTRAR
Program Name: _______________________
Child’s Name: _____________________________________________________________
Registration Date: _____________________
Address: _________________________________________________________________
Fee: $ ________________
check
cash
City/State/Zip: _____________________________________________________________
Registered by: _________________________
Child’s Age: _______ Date of Birth: __________
Phone: _________________________
Family Plan: __________________________
Others registered on Family Plan: _________
Parent/Guardian Name: ______________________________________________________
___________________________________
Parent/Guardian Address: ____________________________________________________
___________________________________
City/State/Zip: _____________________________________________________________
Home Phone: __________________________ Work Phone: ________________________
Willing to help as:
Coach
Team Manager
Email Address: ____________________________________________________________
Official
Field Layout
Concessions
In case of emergency notify: ___________________________ Phone: ________________
Telephone
Program Book
Any physical conditions or allergies? ___________________________________________
Sponsor $ ________________________
Accommodations requested? (please explain) ____________________________________
Other (specify) _____________________
________
REFUND POLICY: No refunds unless program is cancelled prior to start-up date
PLEASE INITIAL
UNIFORMS/EQUIPMENT: I (participant/parent) understand that all program chairpersons, commissioners, coaches and particularly
________
PLEASE INITIAL
participants and parents are responsible for the prompt return of all uniforms/equipment provided by Fallston Recreation Council
sponsored programs. Failure to carry out this responsibility will prohibit a participant from enrolling in subsequent programs, and this
prohibition will apply to all members of the participant’s family, until the uniform(s)/equipment are returned or the program chairperson
is reimbursed.
INSURANCE: I (participant/parent) also understand that I/my child will not be covered by any program insurance and agree that I will
________
PLEASE INITIAL
not hold the team, program, coach, instructor, Fallston Recreation Council, Inc. or Harford County, MD a body corporate and politic of
the State of Maryland responsible for injuries received while participating in the above-noted program.
PARENT/PARTICIPANT RESPONSIBILITIES:
________
1. Respect the team’s coach and abide by his decisions for the team. Do not coach the game from the sidelines nor subvert his
PLEASE INITIAL
authority in any way. You may request to review the program’s by-laws at any time and discuss the coach’s work performance with
the age group commissioner or travel chairman of that program.
2. Be sensitive from the sidelines. Do not jeer at or attempt to distract members of the opposing team. Refrain from offensive
comments to players, coaches, or officials. Spectators exhibiting disruptive behavior will be asked to leave the grounds immediately!
3. Support the drug-free environment that is important for all youth sporting events. The use of alcohol and tobacco products is
strictly forbidden on county property. Violators will be asked to leave the grounds immediately.
4. Model good behavior, respect all participants, encourage all the children, and keep the proper perspective of youth sports.
Parent’s Signature __________________________________________________________________________ Date _________________
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HITE
HAIRMAN
ELLOW
REASURER
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ARTICIPANT

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