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YOUTH REGISTRATION FORM

Guardian Name:

Address:

City:      State:     Zip Code: 

E-mail Address: 

1st Phone:          2nd Phone: 

Event Registering For: 

                                        1st Participant Info                      2nd Participant Info                 3rd Participant Info

Participant's Name (s):     
Gender                                                              
Grade                                                              
Age                                                              
Birthday                                                       
T-Shirt Size S M  L   XL                   S   M   L   XL          S   M   L   XL

Teams will be coached by parents. Please indicate if you would be willing to help coach a team.
                                    YES                    NO

WAIVER

Please read and type in your name below:
I realize that my participation and that of my family members in any program sponsored by the Cherokee Parks & Recreation Department is strictly voluntary.  I acknowledge that there is a risk of accidental injury, and hereby release, acquit, and discharge the City of Cherokee's officers, directors, employees, and/or affiliates from any liability for any and all damages and injuries suffered in any activity or program.

I acknowledge that I have read this waiver and agree to the conditions as set forth therein:

                               

 

                        530 West Bluff Street, Cherokee IA  51012           712-225-2715        cityckerd@evertek.net

Author information goes here.
Copyright © 2001 [OrganizationName]. All rights reserved.
Revised: 05/01/09.