Carbon County Recreation

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Fire Fighter Registration:

$15.00

Quantity:

Item Subtotal:

$0.00

Participant's First and Last Name				[1]
Participant's First and Last Name				[2]
Participant's First and Last Name				[3]
Participant's First and Last Name				[4]
Participant's First and Last Name				[5]
Participant's First and Last Name				[6]
Participant's First and Last Name				[7]
Participant's First and Last Name				[8]
Participant's First and Last Name				[9]
Participant's First and Last Name				[10]

Total:

$0.00

Payer's Information

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Release of Liability/Consent Form:

This consent is for the 2016 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 of such property and or equipment. 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.

Participant(s)

I have read and agree to the statements above.

Please be aware that credit card payments will reflect on your statement as
Carbon UT 800-764-0844 Price UT

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