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McIntosh County Department of Leisure Services

Sports Forms













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Sports Form
















Circle One: Baseball/Softball:Football/Flag Football: Cheerleading: Basketball: Soccer
















                                McIntosh County Department
                          of Leisure Services
                          Registration Form
 
 
Name:__________________________________________________________________
                            Last                                                      First                                 I
 
Mailing Address:________________________________________________________________                                              
           
 
Telephone________________________________Cell:___________________________                                                                                                                                                                                                   
 
Birthdate:________________________________Age:______________________
               Month        Day           Year
 
Check One:    Male_______________Female_______________ 
 
Shirt Size: Youth Small 6-8: Youth Medium 10-12: Youth Large 14-16:
Adult Small: Adult Medium: Adult Large: Adult X-Large: Adult XX-Large:
 
Check One: I Do________Do Not_______ wish for my child to have the offered Insurance Policy. At the cost of $6.00.
 
Child's Physical Condition___________________________________________
List any Physical or Mental condition or diseases(Epilepsy, Heart Murmur, Rheumatic Fever, Etc.) Which your child may have or any other special Medical Information:________________________________________________________.
 
Parent or Guardian Statement
 
I,we the parents/guardian of the above-named boy or girl, hereby give my/our approval for his/her participation in activities during the current season.  I/we assume all ricks 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 McIntosh County Department of Leisure Services, the organizers of the activity, sponsors the supervisiors any or all of them. In case of injury to my/our son or daughter, I/we hereby waive all claims against the orgnaizers, the sponsorss, or any of the supervisors appointed by them.  I/we likewise release from responsibility any person transporting my son or daughter to or from the activity.
         I/we, the parents of the above-named boy or girl, hereby give my/our permission to the person in charge of the activity to take our son or daughter to the doctor or hospital in case of emergency or injury.
 
 
 ParentsSignature:_______________________________________________
 
Department Signature:____________________________________________
 
Date/Paid:______________________________________________________
Last Day of Registration will be at LEISURE SERVICE GYM FROM:
NO TEAM REQUEST ACCEPTED FEE$20.00-INSURANCE$6.00