Kickball Registration Form - 2024

* Required Fields
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Fee: $5.00Internet conveniences fee
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Athletic Registration Form
 IF YOU HAVE NOT PAID WITHIN 48 HOURS OF COMPLETION OF THIS FORM, YOUR REGISTRATION FORM WILL BE DELETED AND YOU WILL NOT BE REGISTERED.
*Select one option:
3-4 Kickball- O S Resident (+$20.00) -- unavailable
 5-12 Kickball O S Resident (+$25.00)
3-4 Kickball Non-Resident (+$30.00) -- unavailable
 5-12 Kickball Non-Resident (+$35.00)
Participant Information
*First Name
*Last Name
*Gender
 Male 
 Female 
*Date of Birth
*Age (as of 08/01/24)
*Street Address
*City
*State
*Zip Code
*T-Shirt Size
*Participant Email
*Home Phone
*Mobile Phone
I would like to be Head Coach
  
I would like to be an Assistant Coach
  
Siblings that need to be on same team-enter name
Participant Medical Information
*Medical Conditions/Allergies
Special Needs/Requests
*Emergency Contact Name
*Emergency Contact Relationship
*Emergency Contact Phone(s)
*Medical Insurance Carrier
*Insurance Policy #
Parent / Guardian 1 Information
*Guardian 1 First Name
*Guardian 1 Last Name
*Relationship
Street Address
City
State
Zip Code
*Guardian 1 Email
*Daytime Phone
Evening Phone
Don't type in this field
Mobile Phone
Waiver
Waiver
In consideration of my minor child/ward being allowed to participate in anyway in this Ocean Springs Parks & Leisure program, related events and activities. The undersigned acknowledges, appreciates and agrees that:
 
  The risk of injury to my child from the activities involved in this program is significant, including the potential for permanent disability and death, and while particular rule, equipment and personal discipline may reduce the risk, the risk of serious injury does exist.
 
For MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child's participation.
 
I willingly agree to comply with the programs stated and customary terms and conditions for participation. If I observe and unusual significant concern in my child readiness for participation in the program itself I will remove my child from participation and bring such attention of the nearest official immediately; and i will conduct myself in an orderly manner or be asked to leave the premises.
 
I for myself, my spouse, my child and behalf of my/ our heirs assigns, personal representatives and next of kin, HEREBY RELEASE, The other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event( Releasees) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property incident to my child's involvement or participation in these programs, WHETHER ARISING RISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
 
I for myself, my spouse, my child, and behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS the City of Ocean Springs, the Ocean Springs Parks & Leisure Services Department, employes of the City of Ocean Springs, all board members, individually Coaches and Assistant Coaches from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
 
UNDERSTANDING OF RISK : I understand the seriousness of the risk involved in participating in this program, my personal responsibilities for adhering to rules and regulations, and accept them as a participant.
 
*Waiver confirmation
 I HAVE READ THIS RELEASE OF LIABLILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING. I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 
Would you like to make a donation to The Children Programs  Ocean Springs Parks & Leisure?
donation
$ 
How did you hear about this program?
Uniform/Equipment Information
Uniform/Equipment Information
It is the responsibility of the Parent/Guardian/Responsible party to verify the uniform size for the child registered prior to OSPL ordering uniforms.  By signing this form, you as the parent/guardian/responsible party agree that the uniform sizes have been verified. 
*Uniform/Equipment Confirmation
 I read and understand the uniform/equipment policy. 
Total Due:
$ 
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