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tration/Release Form Please indicate which sport/activity you are registering for. Note- Age Control Date refers to how old the participant will be on that date, not how old they are now. Baseball (ACD April 30th, 2021) Softball (ACD December 31st, 2020) Football- Tackle (ACD September 1st , 2020) Football- Flag (ACD September 1st, 2020) Soccer Cheerleading Basketball (ACD September 1st, 2020) Parent Information (Print) Mother’s Mother’s Contact Mother’s Father’s Father’s Contact Father’s Emergency Contact Name/Phone Please indicate any interest in volunteer opportunities (Note: These are not guaranteed): Head Coach Assistant Coach Team Mom No Interest Participant Information (Print) Date of Age (as of control Gender:________ Number of seasons Physical/Medical Jersey Size: YS YM YL YXL AS AM AL AXL AXXL Jersey Number Preferences (list 3…Rec Dept. will assign numbers if left blank): Shorts Size: YS YM YL YXL AS AM AL AXL AXXL I understand that the uniform size which I order for my child will be the size he/she receives. If for any reason the uniform size is incorrect, I will be solely responsible for the replacement (order & cost). Requests (Not Guaranteed)/Comments: Walton Co ---PAGE BREAK--- Policy Acknowledgements/Participant Release I acknowledge that the Walton County Parks & Recreation Department does not carry insurance on participants in programs. Being aware of this and acknowledging that participation in any activity involves a certain degree of risk or injury, I hereby waiver, release, absolve, indemnify, and agree to hold harmless the Walton County Parks & Recreation Department, their board of directors, employees, coaches, instructors, officials, and volunteers from any and all liability arising out of any injury suffered by the above said participant during this activity. I understand that the above named parties will not assume responsibility for payment of medical treatment or transportation to or from the place of treatment. Only minor first-aid will be administered when necessary. I further agree to abide by the policies & procedures set forth by the Walton County Parks & Recreation Department. I acknowledge that the registration fee is non-refundable after team drafts/placement and there will be no exceptions. I am aware that a $20 service charge will be applied to all refunds granted prior to team drafts/placement. I understand that the Walton County Parks & Recreation Department may publish participant images and videos to publicize and promote programs offered. I acknowledge that I have received a fact sheet covering concussion awareness from the Walton County Parks & Recreation Department and know what to do if a participant sustains a concussion or other serious brain injury. Parent/Guardian Signature Print Name Date Office Use Only Age Location Registration Taken: Central West South Birth Certificate: attached / on file Fee Paid: Cash:_____ Check Credit Receipt Staff:______