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MARYSVILLE PARKS & RECREATION SUPPLEMENTAL REGISTRATION FORM Please complete one form per participant and email as an attachment to [EMAIL REDACTED] Participant Information Child’s Last Name Childs First Name Date of Birth Gender Male Female Participant Address City Zip Main Contact Phone Email Parent/Guardian Home Phone Cell Parent/Guardian Home Phone Cell Emergency Contact Home Phone Cell Basketball/Soccer Individual/Soccer Team/Sports Camps Grade School Experience Level Beginner Intermediate Advanced Shirt Size YM YL AS AM AL AXL One buddy or coach request School (Buddy requests are not guaranteed.) Summer Camps/Sports Camps In addition the parent/guardian listed above, my child may sign out of camp with the following person(s): 1. 3. 2. 4. My child has allergies or other special needs. It is the responsibility of the parent/guardian to provided related information about any allergies or special needs to the program coordinator. Liability/Photo Release For and in consideration of the opportunity offered to participate in the above named activity offered by the Marysville Parks and Recreation Department, I, as evidenced by clicking the agree button below, do hereby hold harmless, release and waive all claims I or my child may have against the City of Marysville, its officials, employees, agents or contracted instructors, and any other person(s) involved in the registered activity or activities for any and all injuries, losses or damages suffered by me or my child as a result of our participation in the registered activity or activities. I accept full responsibility for the cost of treatment for any injury, losses or damages suffered. I grant to the City of Marysville, its representatives and employees the right to take photographs of me and my property in connection with the registered program. I authorize the City of Marysville, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that City of Marysville may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content. Parent/Guardian Signature Date By checking this box electronically I agree that I have read and understand this waiver. Volunteer Coaches Needed for Basketball and Soccer The Marysville Parks & Recreation’s operation of Youth Basketball/Soccer League is dependent on those parents who become involved in the program as volunteer coaches. Volunteers are these programs most valuable assets. Please consider getting involved on some capacity this year. You will be contacted soon with coaching information. Are you interested in coaching your child’s team? Yes No Possibly Are you interested in being an assistant coach? Yes No Possibly Marysville Parks & Recreation ‐ 6915 Armar Rd. ‐ Marysville, WA 98270 ‐ Phone 360‐363‐8400 ‐ Fax 360‐651‐5089 ‐ marysvillewa.gov