RECREATION SPORTS CONTRACT AND WAIVER
Child’s Birth Name ____________________________________ Nick Name ___________________________
Parents/Guardians___________________________________________________________________________
Address___________________________________________________________________________________
Zip Code ____________________
City Resident County Resident
Telephone (H)___________________(W)__________________ (Cell)______________________
Emergency Telephone_________________ Emergency Contact Person ________________________________
Date of Birth____________________ Age_________ Male Female
Birth Certificate # _______________________________ School __________________________
Did your child play last season? Y / N Coach? _______________________________________
I am willing to be a/an:
___COACH ___ASSIST. COACH ___TEAM PARENT
(help organize snacks,
etc.)
**Email address(s) to contact coaches and assistant coaches
______________________________________________
REGULATIONS:
To be eligible to play recreation sports, a participant and his/her parent or guardian must completely fill out and properly sign this form attesting that
the participant is physically fit for athletic competition and that the parent or guardian consents to such participation. A physical medical
examination, while not compulsory, is highly recommended prior to participating in any department sponsored recreation sport program. Accident
insurance is recommended for all participants in any department sponsored recreation sport program and it is the responsibility of the
parent/guardian to provide such insurance.
PARTICIPATION CONTRACT:
We hereby verify that the above information is true and correct, and that (participant’s name) __________________ is physically fit for athletic
competition. We understand that any false information will result in the loss of center privileges and immediate suspension from the recreation sport
noted below for the remainder of the season. The participant agrees to comply with the rules and regulations for the recreation sport, recreation
facilities and activities as established by the Department of Recreation and Parks.
PARENTAL CONSENT AND WAIVER:
I hereby consent to and approve of the above named child participating in the sport of ___________________. I understand the risks associated with
participating in this sport and hereby waive, for myself and the above named child, any and all claims, demands and right of action against the City
of Richmond, City employees, coaches and officials of the league for any injury or accident which may occur to the said child as a result of
participating in this sport.
*Parent/Guardian Signature____________________________ Date______________
OFFICE USE ONLY
FEE PAID ____________ CHECK # ___________ STAFF INITIAL____________ RCPT. #___________
SHIRT SIZE: (Y) SMALL_____ MEDIUM _____LARGE_____
(A) SMALL____ _MEDIUM ____ LARGE______
