Registration Form

General Details

Family Name: Phone Number: Email: Address: City: Zip Code:

Participant Details

Participant's Name: Gender: Date of Birth: Age: Grade: Shirt Size: Program/League: Fee: Please list any medical/physical problems or limitation in which your child may have of which the league and coaches should be made aware, and if so please explain:

Participant Details

Parent/Guardian Information

Name: Relationship: Address (if different): Home Phone #: Cell Phone #: Work Phone #: Email Address: Interested in coaching?

Release/ Waiver of Liability

I/We the parent(s) or legal guardian(s) of the above named minor hereby give approval for participation in any and all practices, games, and other activities related to the League.

I/We understand that participation in recreational sports may result in serious injury and that protective equipment and other measures do not always prevent injuries.

I/We hereby waive, release, absolve, indemnify, defend, and agree to hold harmless the City of Simpsonville, Municipal Building Corporation, its advisory committee, Simpsonville City Officials, Agents, Employees, Representatives, Parks Board, league organizers, sponsors, supervisors, and participants from activities for any claim arising out of injury to my/our child whether the result of negligence or any other cause.

Additional Information

I give permission for my child's/children's picture (without name) to be used on the Park's Website at cityofsimpsonvilleky.com. and in other promotional pieces. (Pictures used for promoting Park programs and events only). Voluntary donation amount: Total to be charged: Parent/Guardian Signature: Date:

After you click submit you will be redirected to PayPal to finalize your submission. Please note, your registration is NOT complete until after you submit your payment! Be sure to put your last name on your PayPal registration!