YOUTH ATHLETICS REGISTRATION FORM CONTACT: 704.282.4663
5
| rlmoore@monroenc.org | MONROENC.ORG/PARKSANDREC
Participant’s Name:_________________________________________________________________________________________________________ Age:________________________
Date of Birth:________________ Female______________________ Male______________________
Address:_____________________________________________________________________________________ City:_______________________ Preferred Phone #:__________________________________________ Email:______________________________________________________ Parent’s Name(s):___________________________________________________________________________________________________________ Please indicate any physical limitations:______________________________________________________________________________________ How did you hear about this league?________________________________________________________________________________________ Have you played with Monroe Parks and Recreation before?
Yes
No
If yes, which Sport/Team?________________________________________________________________________________________________
COACHES NEEDED!!!!! Would you like to volunteer to be a COACH? If yes, please list contact information: Name:__________________________________________________ Phone:__________________________________________________ *Head coaches will receive reimbursement for registration fee at the conclusion of the season for their child (1 per Head Coach). It is the coach’s responsibility to notify Monroe Parks & Recreation if he/she does not receive the reimbursement check within one (1) month after the season ends.
PARENTS READ CAREFULLY I/We hereby agree to release and waive any claim or cause of action which may occur against Monroe Parks and Recreation staff, authorized persons, or agencies participating in youth sports, arising out of any injury to the person or property during youth sports or in transit to and from athletic activities at different locations. I/We hereby agree and consent for the Monroe Parks and Recreation staff to secure emergency medical attention, if necessary. I/We hereby agree and consent to the use of photographs for publicity purposes associated with youth sports. The undersigned applicant hereby agrees to indemnify and save harmless the City of Monroe from and against any and all loss, costs, damages, expense and liability causes by any accident, illness (communicable diseases such as MRSA, influenza and COVID-19), or other occurrence causing bodily injury or property damage or damage for libel or slander to any person or property arising from or out of the use or occupancy of the premises by the undersigned applicant, its agents, employees, or invitees.
Parent Signature:_____________________________________________________________________________ Date:______________________ Activity:
T-Ball ($20) Flag ($35)
Rookies ($35) Soccer ($60)
Minors ($35)
Majors ($35)
Basketball ($45)
Track & Field ($15)
*Non-Resident Registration fees will apply for Non-City of Monroe Residents **City of Monroe resident youth athletic program participants meeting the eligibility requirements, per UCPS, for free lunch will receive a 30% discount on registration fees. Participant must provide eligibility verification and complete a scholarship application. Shirt Size:
YOUTH ADULT
Pants Size:
YOUTH
(Baseball ONLY)
ADULT
Small Small Small Small
Medium Medium Medium Medium
Large Large Large Large
X-Large Other:___________ X-Large Other:___________
** NO REFUNDS WILL BE ISSUED ONCE PRACTICES BEGIN **
Registration form and fees may be mailed to: PO Box 69, Monroe NC 28111, Attn.: Rae Moore Please make all checks payable to: City of Monroe *FOR DEPARTMENT USE ONLY*
Yes
No
REGISTRATION FEE received: $________________________________
Birth Certificate:
CC_____________ CASH_____________ CHECK#____________
Date Paid __________ / _________ / __________ Staff___________
