I hereby certify that ______________________________is in normal health, has had a physical within the past year, and capable of participating in youth sports. I understand that the purpose of youth sports is fun, personal growth and skill development. I promise to do my part to create that type of environment. Youth Programs has my permission to use any photographs of my self/child for promotional purposes.
Signature: _______________________________________Date:__________________
I would be willing to volunteer as:
_____coach ____assistant coach _____referee ____team parent
WAIVER: The participant registered in recreational activities provided by 10th Services Youth Sports understands that participation in any recreational activity subjects the participant to a certain degree of risk of injury and that the Youth Programs staff will not be liable for medical expenses and other claims for damages based upon any injury to or for damage to any of the personal property of said registrant as a result of participation in these recreational activities. The undersigned hereby agrees to hold harmless and indemnify 10th Services and/or any of its employees and/or volunteers from and against any claims, demands, liability, costs of suit, damages, loss and/or judgement in connection with any use of 10th Services program sites. In the event I cannot be reached in an emergency, I authorize 10th Services to secure proper treatment for my child. Youth Services has permission to video tape or photograph my child while participating in this program.
Parent/Guardian Signature_______________________________________Date:__________________
Printed Name:______________________________________________________
Special Needs/Requests: ______________________________________________________________
_________________________________________________________________________________
Credit Card #: ________________________________ Exp Date: ______________
I authorize the Falcon Trail Youth Center to use my credit card for fees in the above listed activities.
________________________________ __________________________________
Print Cardholder’s Name Signature of Card Holder
Eligible users of 10th Services Division activities are active duty and retired military, NAF and DoD government employees, USAFA cadets and Prep School students, reservists, national guard, and eligible family members. Eligible users of the Officers' and Enlisted Clubs are detailed on those pages. Eligible users of Academy Concerts include the general public. 5/2/07 Web POC
