Carbon County Recreation
             
Carbon County Recreation Youth Activities
Phone: 435-636-3702


Parent/Guardian Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
 
Fall Soccer (Pk (age 3) - 5th grade) No Jersey:   $25.00   Quantity:   Item Subtotal:  
$0.00
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Fall Soccer (PK (age3) - 5th grade) With Jersey:   $39.00   Quantity:   Item Subtotal:  
$0.00
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Football
Flag Football (1st - 6th Grade) No Jersey:   $25.00   Quantity:   Item Subtotal:  
$0.00
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Flag Football (1st - 6th Grade) With Jersey:   $39.00   Quantity:   Item Subtotal:  
$0.00
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Tackle Football (5th & 6th Grade):   $115.00   Quantity:   Item Subtotal:  
$0.00
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Tennis Lessons (Ages 6 & Up)
(Private lessons available, call for details)
Lessons will be on Monday and Wednesday @ 6:00pm


Tennis - 8 Lessons:   $25.00   Quantity:   Item Subtotal:  
$0.00
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Volleyball
Fall Volleyball With Jersey:   $40.00   Quantity:   Item Subtotal:  
$0.00
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Fall Volleyball With Jersey:   $40.00   Quantity:   Item Subtotal:  
$0.00
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Tumbling (Ages 3 & Up)
Tumbling will start September 3, 2019
3:30pm age 3-4
4:30pm age 5-6
5:30pm age 7 and up
Tumbling Per Month:   $20.00   Quantity:   Item Subtotal:  
$0.00
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Total:
$0.00
Payment Information
Method of Payment:
Update name from Parent/Guardian Information
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on Savings Account:
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on Checking Account:
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Release of Liability/Consent Form:

This consent is for the 2018 season. The participants listed above are physically fit and otherwise able to participate in this program. I understand the program will be supervised and I further understand Carbon County Recreation and its employees will not be held liable for any accidental injury incurred while the participants listed above are participating or while being transported to and from games. I authorize emergency treatment for any accident or illness and consent to allow Carbon County Recreation and its volunteers to use their discretion in administering First Aid medical care to all participants listed above.


Code of Conduct Agreement:

As a Parent/Guardian or Participant I agree to adhere to the Carbon County Recreation code of conduct guidelines that include demonstrating sportsmanlike conduct at all times. I agree to treat all volunteers, teammates, refs/officials and the recreational staff with respect and understand that vulgar or offensive language and poor sportsmanship directed at anyone involved will not be tolerated. I also agree to treat county property and equipment properly and may be held responsible for any damage or misuse ofsuch property and orequipment. If at any time I neglect to follow these guidelines I may be asked to leave the premises and participation may be suspended or terminated as deemed necessary by the Carbon County Recreation supervisory staff.


Parent/Guardian Agreement:

I hereby certify that my child/children are in good health and capable of participating in the sports programs selected above and has accident insurance and that Carbon County Recreation and all other participating agencies are not liable for any accident while participating.

I hereby authorize the directors of the Carbon County Recreation Department to act in my behalf in accordance with their best judgement in case on an emergency.

I understand the goal and objectives of the Carbon County Recreation Department, which are based on fun, fair play, skill development and teamwork.
Parent/Guardian - for Participant(s)
I have read and agree to the statements above.

Please be aware that card payments will be described as
Carbon UT 800-764-0844 Price UT

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