WAMEGO RECREATION DEPARTMENT
Office Address: 430 Lincoln Avenue - Recreation Department - Second Floor, 485-456-8810 City Hall - Front Entrance, 785-456-9119
ACTIVITY REGISTRATION FORM
Participant's Name: ___________________________ GIRL/BOY (Circle) Age: _____ As of August 1st Current Year
Address: ________________________ Grade:_______ Birth date: _____________________
City: ______________________ Zip:_________ E-mail Address: ______________________
Home Phone: ________________ Work Phone: ________________ Cell: ____________________
NAME OF PROGRAM OR SPORT: ________________________________________
Volunteers are vital in all facets of Recreation. If you want to help, pick up an application at the Recreation Office or City Office.
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COMPLETE THIS SECTION FOR SPORT PROGRAMS ONLY Has child played this sport before? YES: _______ NO: _______ Please CIRCLE SHIRT SIZE: Youth: Small Medium Large Adult: Small Medium Large X-Large XX-Large *Include copy of birth certificate if one is not on file. WILL YOU COACH? YES: ____NO: ____ ASSIST? YES: ____NO: ____ Name: _____________________ Phone: ________ E-mail: ___________ Shirt Size: ____ Name: _____________________ Phone: ________ E-mail: ___________ Shirt Size: ____ |
Waiver for Participant: In consideration of your accepting this entry, I hereby for myself, my child, my heirs, executors and administrators, waiver and release any and all right and claims for damages I or my child may have while participating in a Wamego Recreation Department program or sport. I assume all risks and hazards incidental to participation and I waive, release, resolve, indemnify and agree to hold harmless the Wamego Recreation Department, The City of Wamego and it's organizers, sponsors, and supervisors. NOTE: Parent or Legal Guardian must sign for any child entering a program.
Signed: ______________________________________ Date: ________________________
To register for an activity or sport program, complete this form and bring to the Recreation Office OR City Hall. Fees must accompany registration form to ensure equipment/supplies are available.
| Staff Use Only:
Receipt #: ____ Cash: ____ Check: ____ Received By: ______ Possible Sponsor: _____ |