PCRA Flag Football - Register Additional Children (copy)

* Required Fields
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Fee: $3.00This internet convenience fee covers QuickScores and PayPal fees.
Attention, only use this form to register your second, third or more children from one family.
*Sport
Participant Information
*Last Name
*First Name
Don't type in this field
*Middle Name
*Street
*City
*State
*Zip Code
*Date of Birth
mm/dd/yyyy
*Age Group (As of Sept 1)
*Gender
 Female 
 Male 
*Phone Number
*School Currently Attending
*School District You Live In
Parent / Guardian Information
*E-mail Address
*Father/Guardian Full Name
*Home Phone
*Employer
*Occupation
*Work / Cell Phone
*Mother/Guardian Full Name
*Home Phone
*Employer
*Occupation
*Work / Cell Phone
Volunteer Information:
 
Parents, if you are interested in volunteering your time and energy to assist in the following areas, please check the appropriate box or boxes below.
Head Coach
  
Assistant Coach
  
Concessions
  
Team Mom
  
Referee / Umpire
  
Scorekeeper / Bookkeeper
  
Other
Medical / Emergency Contacts
Medical Insurance Carrier
Does the player have any present injuries or limitations, allergies, hemophilia,
heart condition, history of respiratory illness, or any other significant medical conditions:  Please select Yes or No below:
*
 Yes 
 No 
If yes, please state problems here
If you wish your family doctor contacted in case of emergency please list name and phone number:
Physician Name
Phone Number
Emergency Contact Name
Relationship
Phone Number
Emergency Contact Address
Special Requests / Notes to PCRA
Waiver / Disclaimer
I, the parent/guardian of the above mentioned individual, acknowledge that participation in athletic events involves risk of physical injuries.  In consideration for accepting the registration of the above name individual and permitting the voluntary participation of said individual in the Morgan County Park & Recreation Department sports program, I hereby release, discharge and hold harmless County of Morgan and the Priceville Community Recreation Association, its volunteers and all other representatives of the County/PCRA from any claims arising out of or relating to any injury that may result to said individual during any Park and Recreation Department / PCRA sponsored events, including any injuries caused by the negligence of any official, referee, coach, Park and Recreation Department / PCRA volunteer or representative while performing his/her duties during any practices, games or transporting of individuals to and from Park and Recreation events.
*Waiver Agreement
 I agree to the above waiver. 
Refund Policy
A refund for the registration fee may be obtained, less any processing fees, if the child registered has not started practices. The refund will only be given through the end of the particular season of the sport for which the child is registered. A refund may also be given under special circumstances but must be approved by the PCRA board. A refund request will need to be issued in written form and given to a board representative or mailed to the
PCRA office. Once approved, a check will be written and mailed to the address on your application on file.
*Refund Policy Acceptance
 I have read and accept the terms of the refund policy 
Total Due:
$ 
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