Overlea-Fullerton Recreation Council Registration Form

Choose Program: Aerobics Baseball Basketball Cheerleading Dance Football Fun Tots Lacrosse Other Skating Soccer Softball Volleyball Other:	Date:
Last Name: First: MI:	Phone:
Address: Zip:
School:	Grade:
Email Address:

Date of Birth: Proof of Age: Birth Certificate Baptism Certificate Family Plan Check No: League: Age: Weight:

DONATION Make Check Payable to: OVERLEA-FULLERTON RECREATION COUNCIL CASH CHECK TOTAL

PARENT/GUARDIAN WILL HELP: Manage Coach Other
EMERGENCY INFORMATION
Person to notify in case of emergency: If under 18, Parent/Guardian

Name:	Phone No:
Address:	Relationship to Participant:
Physician's Name:	Dr. Phone No.:
Date of Last Tetanus Immunization:
Name of Medical Provider:	Policy No:

In case of an emergency, I hereby give my permission for a program representative to call 911 and have my child transported to a hospital. (Digitally signed) Please sign by hand when printing out and submitting with payment.
Signed: Parent/Guardian:

PERMISSION TO PARTICIPATE
I hereby agree to abide by the rules and regulations as established by the local Recreation and Parks Council, I further agree that when I leave this activity or at its completion, I shall return any and all equipment and uniforms issued to me.
(Digitally signed) Please sign by hand when printing out and submitting with payment.
Participant's Signature: Date:
To the Parent/Participant:
For your protection or the protection of your child, please read and complete all information. If the answer to Questions 1 or 2 is "Yes," a medical release form is required.

I hereby approve of the terms of this registration form.  I further agree that I will not hold any Recreation and Parks Council, the organizers, supervisors, volunteer leaders, or participants responsible for injuries or any unforeseen accident while participating in the above named activity. I will inform the chairperson of any medical or health factors which may occur or develop which could affect my child's/my participation.
1. Are there any medical or health factors or limitations that might affect his/her/your safety or performance in this activity?
Yes: No:
2. Are you/your child taking any medication that might affect his/her/your safety or performance in this activity?
Yes: No:
3. Does the participant require any special accommodations (due to disability)? Yes: No:

I hereby state that I/my child am/is in good health and able to participate in this program. I further acknowledge that I have read and fully understand the above-mentioned facts, as well as the Parent's Code of Conduct and the fact that the Baltimore County Department of Recreation and Parks does not provide background checks on volunteers.  I certify that all answers, to the best of my knowledge, are true and correct. I further understand and agree that my donation is non-refundable.
Digitally signed) Please sign by hand when printing out and submitting with payment.
Participant's Signature: Date:

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