BEDFORD PARKS AND RECREATION
PO BOX 475
330 EAST JOHN STREET
AND RELEASE FORM
HOME PHONE ______________________________PARENTS WORK PHONE _____________________
BIRTH DATE _____________________________________________ AGE _______________________
If you were on a team last year, please list the team:____________________________________
the program for which this registration is being made:
BASKETBALL BASEBALL CHEERLEADING FOOTBALL SOFTBALL VOLLEYBALL WRESTLING
We, the parents of __________________________________,
have seen that our child has been examined by a physician and is in sound physical health.
We agree to provide accident insurance through our private company to cover our child, as the Bedford Area Board of
Parks and Recreation will carry no insurance. We are aware and understand there
are certain assumed risks involved with our child’s participation in the activity circled above, and we will not hold
the Bedford Parks and Recreation and/or any of the sponsoring agencies liable for any personal loss or injury that may occur. We are aware that the Bedford Board of Parks and Recreation does NOT sanction or sponsor
any competition that involves children from outside the municipalities listed below.
circle area of Residency:
Cumberland Valley Township
Manns Choice Borough
Snake Spring Township
Parent/Guardian Signature: _________________________________________ Date: ______________
Signing this form verifies that you have received the Parents Code of Conduct
and will abide by the rules listed.
$10.00 REGISTRATION FEE