Sports Registration Form (English)

Anne Stroud Taylor Recreation & Wellness Center

GENERAL SPORTS REGISTRATION FORM
184 PARK CIRCLE - FAISON, NC 28341

Phone: (910) 267-0115 Fax: (910) 267-1848
PLEASE DO NOT PROCEED WITH REGISTRATION UNLESS YOU ARE PREPARED TO MAKE PAYMENT TODAY
Child's Name*

First NameLast Name
Gender*

BoyGirl
Date of Birth *
Current Age*
Parent or Guardian (Primary Contact)*

First NameLast Name
Phone Number (Cell Number)*
Please enter a valid phone number.
Email*
example@example.com
Parent or Guardian

First NameLast Name
Phone Number (Cell Number)
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (If other than parent)

First NameLast Name
Sport Requested*
Shirt Size*
List any specific requests or instructions associated with this registration. Specific coach requests will be considered but not guaranteed.
LIABILITY WAIVER

In consideration of being allowed to participate in any way with the Town of Faison Recreation and Wellness Center's athletics, fitness room and/or related activities, the undersigned:

1. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious personal injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inactions or neglilence, but the actions, inactions or negligence of others, the rules of play, or from conditions of the premises or of the equipment used. Further, there may be risks not known to us or not reasonably foreseeable at this time.

2. Assume all the foregoing risks and accept personal responsibility for the damages of equipment and self.

3. Release, waive, discharge and covenant not to sue the Anne Stroud Taylor Recreation & Wellness Center, the Town of Faison, Board of Commissioners and Employees from any and all liability to each, including death or damaged property.
STAFF MEMBERS HAVE COMPLETE AUTHORITY TO ASK ANYONE TO LEAVE THE PREMISES AT ANY TIME.
Are you interested in being a coach?*
Printed Name of Parent/Legal Guardian Signing the Registration Form *
Date*

MonthDayYear
Date
ONCE YOU SUBMIT YOUR REGISTRATION YOU WILL BE REDIRECTED TO THE PAYMENT PAGE.

PLEASE NOTE THAT REGISTRATION IS NOT COMPLETE AND YOUR CHILD WILL NOT BE ABLE TO PARTICIPATE UNTIL PAYMENT IS RECEIVED.
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Anne Stroud Taylor Recreation & Wellness Center

184 PARK CIRCLE - FAISON, NC 28341