PS Master Registration

Child's Full Name*

First NameLast Name

Date of Birth*

MonthDayYear

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Does your child have any behavioral, cognitive, or emotional issues or conditions?

Does your child have any environmental allergies? Dietary requirements? Or medical issues?

Will your child need to have medicine administered during the day?*

YesNo

Is there a family situation and/or custody concern about which we need to be aware? *

YesNo

Parent/Guardian and Pick-Up Information

Parent/Guardian 1*

First NameLast Name

Phone Number*

Area CodePhone Number

Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Parent/Guardian 2*

First NameLast Name

Phone Number*

Area CodePhone Number

Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Pick Up #1

First NameLast Name

Phone Number

Area CodePhone Number

Pick Up #2

First NameLast Name

Phone Number

Area CodePhone Number

Pick Up #3

First NameLast Name

Phone Number

Area CodePhone Number

Enrollment

Which monthly option will your child attend for Preschool?*

Do you have a current SportsPlex Family Membership?*

YesNo

Tuition

Payment Options*

E-mail

A registration fee of $50 per child is required to enroll. This fee is non-refundable.

In enrolling at Orange County Sportsplex, participant understands that he/she attending the programs and using Orange County Sportsplex and the facilities does so at his/her own risk. Orange County Sportsplex and its owners, employees or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant with his/her family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises, He/She does hereby fully and forever release discharged hold harmless Orange County Sportsplex, all associated facilities and its owner, employees, and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by Orange County Sportsplex. Failure to do so may result in suspension from participation. Consent: I the undersigned parent or guardian/participant do hereby grant authority to the staff at Orange County Sportsplex to render a judgement concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize Orange County Sportsplex and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in its promotional materials or team films.

I agree/accept I do not agree

Enter the message as it's shown*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

KidsPlex Preschool Master Registration