Youth Registration Form

2. Youth Program Registration Form

3. 

5. The undersigned being the parents or guardian of the child listed below a minor, consent and assent to said child's participation int he athletic ventures, games, and sports events sponsored by the Skowhegan Parks and Recreation Department and /or Skowhegan Sports Boosters, and by this consent and assent do hereby assume all responsibility for any and all injuries and /or damages related thereto the undersigned, jointly and severally, agree to indemnify, protect, and save harmless the Skowhegan Parks and Recreation Department, the Skowhegan Sports Boosters, their officers, directors, agents, servants, and employees from any and all judgements, costs, and expenses whatsoever arising on account of any action, claim, or demand by said minor, or by any person acting for or an behalf of said minor in respect of any claimed injuries or damages. Photographs/Videos: The Department of Parks and Recreation may take pictures and or videos of participants at our programs, activities or special events. Please be aware that the picture and or video may appear in future promotional materials, including our brochures and web site.

   The undersigned being the parents or guardian of the child listed below a minor, consent and assent to said child's participation int he athletic ventures, games, and sports events sponsored by the Skowhegan Parks and Recreation Department and /or Skowhegan Sports Boosters, and by this consent and assent do hereby assume all responsibility for any and all injuries and /or damages related thereto the undersigned, jointly and severally, agree to indemnify, protect, and save harmless the Skowhegan Parks and Recreation Department, the Skowhegan Sports Boosters, their officers, directors, agents, servants, and employees from any and all judgements, costs, and expenses whatsoever arising on account of any action, claim, or demand by said minor, or by any person acting for or an behalf of said minor in respect of any claimed injuries or damages. Photographs/Videos: The Department of Parks and Recreation may take pictures and or videos of participants at our programs, activities or special events. Please be aware that the picture and or video may appear in future promotional materials, including our brochures and web site.

7. Childs Name
   Please fill in the Child's First and Last Name

   Please fill in the Child's First and Last Name

8. First Name*

   Child's First Name

9. Last Name*

   Child's Last Name

11. Program :*
    -- Select One --Exercise Room, Open Gym, Weight , game rooms and the use of locker and showers

    Select the Program you are signing up for.

12. Programs for Non Residents
    -- Select One --Open Gym, exercise an weight rooms, game room, and the use of locker rooms and showers $50

14. Child's Name

15. Male or Female

    1. Male
    2. Female

16. Age

    Age of Child

18. Grade

19. Name of School
    -- Select One --Margaret Chase Smith SchoolNorth Elementary SchoolMiddle SchoolBloomfield SchoolHigh SchoolSomerset Career and Technical CenterMarti Stevens School

20. Date

24. Parent or Guardian Info:

26. First Name

27. Last Name

28. Home Phone

30. Work Phone

31. Cell #

32. Email Address

34. Mailing Addresss

35. Town

36. Zip Code

38. Street Address

39. Town

40. Zip code

44. I (we) give permission for Emergency Medical Treatment to be given to our child, in case I (we) cannot be reached by Phone

45. Emergency Contact Person & Phone .

46. 2nd emergency contact person & Phone

48. Please list any allergies, Medical conditions, Physical limitations/restrictions Your child may have:

52. When applicable (Please check size) T-Shirt Size:

    1. YXS (2-4)
    2. YSM (6-8)
    3. YM (10-12)

    1. YL ( 14-16)
    2. AS
    3. AM

    1. AL
    2. AXL

54. I would like to volunteer by:

    1. Coaching

    1. Assistant Coach

    1. Other

56. Signature of Parent/Guardian*

    By typing your name here you agreeing to this contract.

57. Today's Date

61. For Office Use Only

63. Date
    Date

    Date of acceptance of form

64. Total Amt Paid $

65. Check #

66. Cash $

68. Received by
    -- Select One --Denise LeblancBrent CookEvan Kingsbury

69. Receipts #

Leave This Blank:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit Submit and Print

* indicates a required field