DATE

Child's Name (Last, First, Middle, Name Preference)

Parent/Guardian's Name

Phone Number (Home)

Phone Number (Work)

Street Address (Home)

Mailing Address (Work)

Child's Date of Birth

Child's Age

Male or Female

Program (Basketball, T-Ball, Coach Pitch Baseball, Girl's Softball)

Previous Team Placement

Desired Team Placement

Release of Liability I do hereby and forever discharge the participants, instructors, and administrators of the Morehead City Parks and Recreation Department from any and all actions, claims, and demands for or by reason of any damage, loss or injury which hereafter may be sustained by me or my child in consequence of participation by said person in this program. I hereby acknowledge and admit that the Morehead City Parks and Recreation Department shall not be required to carry any insurance protection for the participants and thereby do agree to provide individual insurance coverage for myself and child. Permission is hereby granted for my child to participate in the Morehead City Parks and Recreation Department's program.
I also agree that submitting this registratin form electronically implies the same understanding and agreement as my seal or signature and carries the same force and effect.

Parent/Guardian Signature