Recreation Registration

E-mail Address: *
Sport *
Baseball
Soccer
Basketball
Participants Name *
Address *
City *
State *
Zip *
Parents Names *
Home Phone *
Dads Work *
Dads Cell *
Moms Work *
Moms Cell *
Date of Birth *
Age *
Sex *
School *
Grade *
Email Address *
Emergency Contact *
Emergency Phone Number *
Medical Concerns that should be known in case of emergency *
Church You Attend *
I, hereby release and discharge Second Baptist Church, its agents, employees, and coaches from all claims, actions, causes of action, or demands which I, my heirs, for any and all injuries known or unknown which my child has or may incur by participating in the above mentioned activity. *
I have read this release and AGREE to its terms.
I have read this release and DISAGREE to its terms
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