Cockeysville Recreation Council Registration

This registration form must be completed by the participant, or if the participant is a minor/child, by the legal authorized parent or guardian of such minor/child participant. You only need to complete 1 for each school year. *****Please note that this is NOT a BCPS sponsored event/activity.*****
Cockeysville Recreation Council Registration - CYC Registration

Questions when completing the form? Email Cockeysvillecyc@gmail.com
Participant Name *

First Name Last Name
Participant's School *
Participant's Grade *
My child is a guest of the following CMS student named:

First Name Last Name
If you have another child to register, please add their information in Participant #2. Otherwise leave boxes blank.
Participant #2 Name

First Name Last Name
Participant #2 School
Participant #2 Grade
PARENT/GUARDIAN NAME *

First Name Last Name
Parent/Guardian Email Address *
example@example.com
Parent/Guardian's Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
CHAPERONES/VOLUNTEERS NEEDED

CYC is a completely volunteer run event. We need parent/guardians to volunteer as chaperones. As a condition of your child(ren) attending CYC, we ask that ALL parent/guardian volunteer for at least one CYC. Volunteers are needed from 6:35pm - 10:00pm. As a thank you, children of volunteers attend CYC FREE!!! IF WE DO NOT HAVE ENOUGH VOLUNTEERS, CYC WILL BE CANCELLED. To sign up to volunteer at a CYC, please copy and paste this link into your browser: https://www.signupgenius.com/go/10c0f48a8a928aafa7-cycvolunteers
Which dates does your child plan on attending? Select all that may apply (it is ok if you change your mind on dates - it just gives us a gauge on attendance). You only need to fill out 1 form each school year that you child is in middle school. No other grades are allowed to attend. *

October 7, 2022 November 11, 2022 December 2, 2022 January 6, 2023 February 10 , 2023 March 10, 2023 April 14, 2023 May 19, 2023

Emergency/Health Information

Emergency/Health Information: In case of an emergency, please notify (if minor/child participant, provide parent’s information or Guardian, as applicable).
Emergency Name

First Name Last Name
Relationship to Participant
Phone Number

Area Code Phone Number
Physician's Name

First Name Last Name
Physican Phone Number

Area Code Phone Number
1. Are there any medical or health factors or conditions that might affect participant’s performance in activity? *

Yes No
2. Is participant taking any medications or have a condition that may affect participant’s safety or performance in the activity? *

Yes No
3. Is participant required any special accommodations (due to disability) to participate in the activity: *

Yes No
If answer to #3 is yes please explain
In case of injury or emergency, I for myself and/or participant (if participant is minor/child), and my personal representatives, heirs and assigns, (severally and collectively “I”) for this registration form) give permission for an activity representative to call 911 and transport participant to a hospital. I shall inform the Recreation Council, in writing, of any medical or health conditions of participant that occurs or develops and which could affect participant’s safety, performance or participation in or throughout the activity.
Date

Month Day Year
Date
Signature

Clear

CYC Rules. Students are expected to exhibit appropriate behavior. Inappropriate behavior includes the following: disrespecting parents and chaperones, cursing, hitting, fighting (physical or verbal), kissing, hugging, lap sitting, very physical dance style (grinding or twerking), running, horseplay, jumping on backs, break dancing whereby the feet are in the air, dance circles must have a chaperone inside. Students cannot yell out the inappropriate words from songs where such inappropriate words have been bleeped out.
I have read the above rules and agree to abide by said rule. Parent/Guardian Signature *

Clear
Leaving CYC: Students are not allowed outside unless accompanied by a parent. PARENTS MUST PARK THEIR CAR AND ENTER CYC TO PICK UP STUDENTS. UBER and LYFT services are NOT accepted transportation home for students. Parents must pick up students by 10:00 pm. Parents are welcome to walk around the facility and find their child. A late fee of $1.00/minute is charged for every minute past the 10-minute grace period (10:10 pm).
I have read the above rule regarding Leaving CYC and agree to abide by said rule. Parent/Guardian Signature *

Clear

Dress Code. Dress code for CYC is the same as that for BCPS and CMS:*Must wear shoes (flip flops are ok). No pajamas and/or flannel pants *Keep undergarments covered *No clothing or accessories related to drugs, alcohol, profanity, or sex *Stomach, back and buttocks cannot show with or without your hand being raised*No chains of any kind. No studded accessories *All tank top straps must be three adult fingers in width *No low cut, tight, or short clothes *Shorts and skirts may not be shorter than fingertips stretched down and by your side *If you do not follow the dress code, you will be asked to change your attire. *For the safety and concern of all participants, NO HATS or HOODS.
I have read the above rule regarding Dress Code and agree to abide by said Rule. Parent/Guardian Signature *

Clear

Offenders. There is a zero tolerance for offenders, as these rules are published on the web site and reviewed during online registration. Students who do not abide by these rules will be asked to leave the CYC or isolated until a parent can pick them up or the CYC is over.
I have read the above rule regarding Offenders and agree to abide by said rule. Parent/Guardian Signature *

Clear

Acknowledgement, Waiver & Release of Liability

I hereby confirm participant is in good health and able to participate in the activity. Also, I have been advised to consult with a licensed physician prior to participation in the activity. I acknowledge the activity may involve exposure to communicable diseases, apparent and inherent risks, dangers of bodily injury or death and damage to property. I fully accept and acknowledge the activities may involve risks, and I hereby assume all dangers and risks associated with participating in the activity and will be responsible for the same. I further understand that concussion information is available at www.cdc.gov/concussion. I acknowledge that Baltimore County, Maryland, the Recreation Council, and their respective employees, directors, officers, volunteers, members and any other participant, entity, party or person involved in any regard with the Activity or the Activity premises and their respective agents, personal representatives, heirs, employees, contractors, successors and assigns (each an activity representative and collectively the “activity representatives”), shall not be responsible or liable in any regard or manner for any and all property damage or illness or bodily injury (including serious physical injury or even death) incurred by participant or any party related thereto, as a result of his/her participation in the activity. I have read, fully understand, and hereby freely sign, approve of, and agree to the terms of this Registration Form. I hereby expressly and forever unconditionally release, discharge, covenant not to sue, waive my rights and remedies, and agree to hold harmless and indemnify the activity representatives from any and all claims, costs, demands, losses, damages, or expenses, and from all acts of active or passive negligence or other fault on the part of the activity representatives associated with, in whole or in part, participant’s involvement with the activity. I shall inform the Recreation Council in writing if any information provided in this Registration Form is incorrect or changes through the course of the activity. I shall present a government issued photo identification card including, but not limited to, my driver’s license, passport, or United States Visa to the activity representative for review, if requested, at the time I submit this Registration Form to the recreation council
I have read the above Acknowledgement, Waiver & Release of Liability and agree to abide by said acknowledgement. Parent/Guardian Signature *

Clear
Name

First Name Last Name
Should be Empty:

This registration form must be completed by the participant, or if the participant is a minor/child, by the legal authorized parent or guardian of such minor/child participant. You only need to complete 1 for each school year. *****Please note that this is NOT a BCPS sponsored event/activity.*****

Cockeysville Recreation Council Registration - CYC Registration

CHAPERONES/VOLUNTEERS NEEDED

Emergency/Health Information

Offenders. There is a zero tolerance for offenders, as these rules are published on the web site and reviewed during online registration. Students who do not abide by these rules will be asked to leave the CYC or isolated until a parent can pick them up or the CYC is over.

Acknowledgement, Waiver & Release of Liability

This registration form must be completed by the participant, or if the participant is a minor/child, by the legal authorized parent or guardian of such minor/child participant. You only need to complete 1 for each school year. Please note that this is NOT a BCPS sponsored event/activity.