Page 15 - 2021-SpringActivitiesGuide

REGISTRATION FORM

PARTICIPANT’S NAME: BIRTH DATE: AGE: GENDER:
Last First
ADDRESS: CITY: ZIP:

PH#: WORK PH#: EMAIL:

GRADE: SCHOOL: PARENTS NAME:

SECONDARY CONTACT: SECONDARY PHONE:

PROGRAM NAME DIVISION DATE OF CLASS TIME FEE

Scholarship Donation

TOTAL

YOUTH SPORTS ONLY
Please complete the following information to help balance teams. PLAYER REQUESTS WILL NOT BE TAKEN. Thank You.

Height: Weight: # of seasons previously played in this sport:

T-Shirt Size: (Please circle) YXS - YS - YM - YL - AS - AM - AL - AXL
Sizes (2-4) (6-8) (10-12) (14-16)
I am interested in coaching or asst. coaching — Name Contact #:

I am interested in sponsoring a team — Name of Business Contact #:
Medical Conditions:

WE ACCEPT CASH, CHECK, AND CREDIT/DEBIT CARD. MAKE CHECKS PAYABLE TO: CITY OF POST FALLS (A $20.00 fee will be charged on all NSF checks.)

WAIVER AGREEMENT
I hereby agree to participate (or allow my child to participate) in the above-named program, which is a recreational or educational activity to be conducted by the city of Post Falls, and do hereby
acknowledge that such participation presents risks, some of which are unknown. I agree to assume all risks associated with such participation. I do, on behalf of my child/ward and any persons who may
have an interest in his/her well-being or property, hereby release and forever discharge the City of Post Falls, Idaho, its agents, servants, employees and cooperators from any and all real possible claims for
damages or other harm to person or property, regardless of the manner by which any such claim may be brought. I accept the terms of this complete and total release and agree to be bound by it of my own
free will. I understand that the Post Falls Parks & Recreation Department may use mine or my child’s picture for promotional purposes.
I hereby consent to first aid, emergency medical care, and authorize, if necessary, admission to a hospital for treatment of injuries that myself or my child/ward could sustain while participating in this
program. I understand that I am responsible for any and all medical expenses which may be incurred as a result of any accident or illness while participating in the program.
I ACKNOWLEDGE, agree and represent for myself and my minor child(ren) that I understand the nature of the current COVID-19 pandemic, and have made myself familiar with the current guidelines
regarding activities during the pandemic including, but not limited to, guidance from the United States Centers for Disease Control and Prevention, Panhandle Health District and other federal, state and local
governments. That I/my child(ren) am/are qualified, in good health, and in proper physical condition to participate in such activity with full knowledge of the risks and dangers associated with a group sporting
activity that involves close physical contact with others that makes safe social distancing impossible.
I AM THE PARENT OR LEGAL GUARDIAN, Of THE ABOVE-NAMED PARTICIPANT, WHO IS REFERRED TO IN THIS AGREEMENT AS MY CHILD/WARD. MY APPROVAL OF THIS AGREEMENT MEANS THAT I CANNOT LATER
BRING A CLAIM FOR DAMAGES AGAINST THE CITY OF POST FALLS AND ANY COOPERATORS IN THIS PROGRAM.

SIGNATURE OF PARENT/LEGAL GUARDIAN, OR PARTICIPANT (IF OVER 18) DATE

RETURN TO: P.F. PARKS & RECREATION • 408 N. SPOKANE STREET • POST FALLS, IDAHO 83854 • PHONE (208) 773-0539 • FAX (208) 773-7658
WWW.POSTFALLSIDAHO.ORG/ONLINE | 15