KNOX COUNTY PARKS AND RECREATION YOUTH SPORTS REGISTRATION
Organization:
Farragut Baseball Inc.
Division (Player's age as of 4/30/2022)
*
4U TBall
6U Ozzie Smith
7U Hank Aaron
8U Roberto Clemente
10U Willie Mays
12U Pee Wee Reese
14U Sandy Koufax
18U Mickey Mantle
Not Sure
Age Division
Student-Athlete Full Name (no nickname, etc.)
*
First Name
Middle Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School
*
School Name
Grade
*
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Grade
Seasons in this sport
*
# Seasons played, not years (i.e., Spring and Fall = 2)
Seasons in other sports
*
# Seasons played, not years (i.e., Spring and Fall = 2)
Do you have medical insurance
*
Yes
No
Carrier
*
Insurance carrier
Policy #
*
Policy #
Doctor's Name
*
Doctor's Phone Number
*
-
Area Code
Phone Number
Please list any medical condition(s), disabilities, present injuries, heart or respiratory illness or other conditions that may affect this child’s ability to participate (if none put n/a):
*
Father/Guardian Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mother/Guardian Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
EMERGENCY AUTHORIZATION If there is an emergency during participation in this program and I or another parent or guardian is not present, I authorize treatment and/or care at any hospital and I hereby authorize the volunteers and staff of this program as my agents. If I cannot be reached please contact the following person who is hereby authorized on my behalf:
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: To accept registration and permit participation in Knox County programs by the named participant, I the parent or guardian of said participant, hereby give my consent and agree to release, indemnify, and hold harmless Knox County, its officials, coaches, representatives and volunteers from any claim arising out of injury to the named participant. I acknowledge that Knox County does not provide medical insurance of any kind to participants. For myself and on behalf of my heirs, assigns and next of kin, I acknowledge that participation in this program may include travel, participation on adverse field conditions, and risk of physical injury or death. For myself and on behalf of my heirs, assigns and next of kin, I willingly and voluntarily accept and assume all such risks of participation. I hereby release, discharge and agree to hold harmless Knox County, its employees, volunteers, officials, sponsors and other representatives from any and all claims, demands, costs, expenses and compensation arising out of or in any way related to any injury or other damage that may result to the participant while participating in this Knox County sponsored activity. I have read and agree to abide by the Knox County Sports Code of Conduct.The below signed parent or legal guardian has read and understood the above information.
Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Signature
*
I am interested in volunteering for:
Head Coach
Assistant Coach
Team Parent
Other
Submit
Should be Empty: