REV 01/21
Participant’s Name: Date of Birth:
first name last name
Parent / Guardian Name:
Address: Phone:
Email:
Emergency Contact 1 Name: Phone:
Emergency Contact 2 Name: Phone:
(check one each)
Shirt: Youth S M L XL Adult S M L XL XXL
Pant: Youth S M L XL Adult S M L XL XXL
Name for back of jersey:
Number for back of jersey: 1
st
Choice 2
nd
Choice
Please note – there are no refunds or exchanges on uniforms.
Any negative action or violation of the Recreation Code of Conduct during the course of any Village sponsored
program/event may result in the dismissal from the above listed program/event.
While we realize that the Village of River Grove will take every possible safety precaution in the performance
and operation of the above event or program, we the undersigned, adult or parent/guardian, acknowledge that
The Village of River Grove, it’s employees, supervisors and representatives cannot be held liable for any
accidental injury or illness. In cases of minors, you give your consent for emergency care to be called for and
administered if the situation should arise.
Signature of Parent/Guardian Date Printed Name of Parent/Guardian Date
OFFICE USE ONLY
PAID: $ CHECK # CREDIT CARD CASH Initials:
2621 THATCHER AVE, RIVER GROVE IL 60171
DAVID B. GUERIN, PRESIDENT
PHONE 708-453-8000 FAX 708-453-0761
ROCKETS SOFTBALL REGISTRATION
ljardine@rivergroveil.gov
click to sign
signature
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