Duchesne City Recreation
             
Duchesne Recreation Flag Football
Grades: K-2nd

Grades are based on the grade the child will be in this coming school year.
Registration is all online Aug 10th - Sept 1st at duchesnecity.com
****NO REFUNDS****

Each player will get a Duchesne Recreation Flag Football t-shirt and get the opportunity to learn the game of football.
All practices and games will be played in Duchesne on Tuesday and Thursday evenings.
The season will start the week of September 10th and go approximately 4-5 weeks.

Flag Football Registration:   $30.00   Quantity:   Item Subtotal:  
$0.00
Participant's First and Last Name [1]
T-Shirt Size [1]
Participants Grade for the 2018-2019 year [1]

Participant's First and Last Name

[2]
T-Shirt Size [2]
Participants Grade for the 2018-2019 year [2]

Participant's First and Last Name

[3]
T-Shirt Size [3]
Participants Grade for the 2018-2019 year [3]

Participant's First and Last Name

[4]
T-Shirt Size [4]
Participants Grade for the 2018-2019 year [4]

Participant's First and Last Name

[5]
T-Shirt Size [5]
Participants Grade for the 2018-2019 year [5]

Participant's First and Last Name

[6]
T-Shirt Size [6]
Participants Grade for the 2018-2019 year [6]

Participant's First and Last Name

[7]
T-Shirt Size [7]
Participants Grade for the 2018-2019 year [7]

Participant's First and Last Name

[8]
T-Shirt Size [8]
Participants Grade for the 2018-2019 year [8]

Participant's First and Last Name

[9]
T-Shirt Size [9]
Participants Grade for the 2018-2019 year [9]

Participant's First and Last Name

[10]
T-Shirt Size [10]
Participants Grade for the 2018-2019 year [10]
Do you have a teammate request?
Flag Football Picture(s):   $12.00   Quantity:   Item Subtotal:  
$0.00
 
Total:
$0.00
 

Parent/Guardian Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Cell Phone Number
 
Are you willing to be a coach or team parent?
Coach
Team Parent
In Emergency Notify
Emergency Phone Number
 
Payment Information
Method of Payment:
Update name from Parent/Guardian Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Parent/Guardian Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
 

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 Duchesne City 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 Duchesne City and its volunteers to use their discretion in administering First Aid medical care to all participants listed above.

I Agree
I have read and agree to the above disclaimer
Use Instant Payments to accept payments for your business.
SIP Program & Data © 2006-2018 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
SIP master Version 2.17; API: 2.4
Get Help RSI Security Instant Payments, Payment Processing Service, Clinton, UT