Milford City Recreation ______________________

Program Grade/s ______________________

Player/Parent Registration Form

Please Print Name of Player ___________________________________________________________ Last First MI Address ________________________________________ City______________ Zip __________ Name of Parent or Guardian ________________________________________ PO Box ________ Telephone: Home_______________ Date of Birth _____________ Age _____ Grade __________ month/day/year Emergency Notification _____________________________________ Telephone _____________

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Parent’s Agreement

 I hereby certify that ____________________________ is in normal health and is capable of participating safely in the _____________________________ Program and has Accident and Health Insurance and that Milford City Recreation and all other participating agencies are not liable for any accident while participating in the Program. I hereby authorize the directors of the Program to act on my behalf in accordance with their best judgment in case of an emergency. I understand the goals and objectives of the Program is the teaching of skill development, fair play, teamwork, sportsmanship, and to have fun. I further agree, in the case of the football program, to return any and all related equipment and/or clothing issued by the City for the program. I, as a parent or guardian, am willing to participate as a volunteer in support of this program as checked below: ___ Coach ___ Asst. Coach ___ Referee ___ Volunteer ___ Volunteer Driver Shirt Size: Youth S______ M______ L______ XL______ (If program allows) Adult S______ M______ L______ XL______

Signature of Parent or Guardian ____________________________________________________ Return this form with Fee to the Milford City Office by _______. _______ ____, 200__.

Make checks payable to: Milford City. (Form will not be processed nor equipment issued without payment and a signed indemnification form) Payment is non-refundable

Call the city office for particulars on a given activity. 387-2711