Moore County Parks And Recreation Youth Activity Registration Form

MOORE COUNTY PARKS AND RECREATION YOUTH ACTIVITY REGISTRATION FORM:

ACTIVITY FEES: Soccer- $30 / Baseball/Softball- $30 / T-ball/Coach Pitch-$25 / Flag Football-$30 / Basketball-$25

LATE FEE: $10 AFTER REGISTRATION DEADLINE IF SPACE IS AVAILABLE!

**Proof of age must be presented to the Parks and Rec. Dept to be eligible to participate **

PRIMARY PARENT INFORMATION:

SECONDARY CONTACT INFORMATION:

__________________________

_________________________________

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First Name

Last Name

First Name

Last Name

_____________________________________ _________________________________

_____________________________________ ________________________________

Street Address

Mailing Address

Street Address

Mailing Address

________________________________________ _______ _____________

________________________________________ _______ _______________

City

State

Zip Code

City

State

Zip Code

Cell Phone: ________________________ Home: _______________________

Cell Phone: _________________________ Home: ____________________________

To receive Text Messages about Game Cancellations

To receive Text Messages about Game Cancellations

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and Registration Information, CHECK HERE

and Registration Information, CHECK HERE

Email: ____________________________________________________

Email: ____________________________________________________

PERMISSION, RELEASE, AND ASSUMPTION OF RISK: I, the undersigned Parent/Guardian, permit my child to participate in activities or programs offered by the Moore County Department

of Parks and Recreation. I give permission for my child to participate in out-of-town activities or programs and to be provided with transportation to and from those activities or programs. I

understand that my child shall abide by all rules of the Moore County Department of Parks and Recreation or risk expulsion from the activities or programs. I understand that my child may suffer

accident or injury, including death, as a direct or indirect result of participation in the activities or programs and I agree to assume any and all risk involved with my child’s participation. In the

event my child is injured, I will not hold the County of Moore or its agents, volunteers, or employees responsible or liable. If I cannot be contacted, I give permission to the Department of Parks and

Recreation to give medical attention to my child as deemed necessary. I release to the Department of Parks and Recreation any video or images of my child taken during the activities or programs,

which may be used for promotional purposes. Further, I understand the terms of this Permission, Release, and Assumption of Risk and agree that it is binding upon me and my child, family, estate,

heirs, and assigns.

:

Registration Information

Payment is due at the time of registration :

________CASH _________CHECK # ______CREDIT CARD (In office )

*Shirt

First Name

Last Name

Birth Date

Age

Sex

Activity

Fee

School Attending

Size

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ADDRESS

: Moore County Parks & Recreation PO Box 905 Carthage, NC 28327 Phone-910-947-2504 Total:

Signature of Parent/Guardian: ______________________________________________________

Date: ___________________________________

CHECK IF INTERESTED: COACH

ASSISTANT COACH

SPONSOR

PERSON INTERESTED: _____________________________________________________