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Bedford Parks And Rec

Registration Form
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REGISTRATION FORMS

 

 

 

 

 

 

BEDFORD PARKS AND RECREATION

PO BOX 475

330 EAST JOHN STREET

BEDFORD, PA  15522

parksandrec@bedford.k12.pa.us

Phone 814-623-5693

 

 

REGISTRATION AND RELEASE FORM

 

 

NAME________________________________________________GRADE ____________________

 

ADDRESS ___________________________________________________________________________

 

E-MAIL ADDRESS_____________________________________________________________________

 

HOME PHONE ______________________________PARENTS WORK PHONE _____________________

 

BIRTH DATE _____________________________________________ AGE _______________________

 

If you were on a team last year, please list the team:____________________________________

 

 

Circle 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.

 

Please circle area of Residency: 

Bedford Borough                                    Bedford Township

                         

                                                Colerain Township                     

Cumberland Valley Township

                                                Harrison Township                     

Hyndman Borough

                                                Londonderry Township                Manns Choice Borough

                                                Rainsburg Borough                    

Snake Spring Township

 

Parent/Guardian Signature: _________________________________________ Date: ______________

Print Name:__________________________________________________________________________

Signing this form verifies that you have received the Parents Code of Conduct and will abide by the rules listed.

 

 

 

$10.00 REGISTRATION FEE

 

PAID:___________________________________________

 

 

 

 

 

 

Code of Conduct