Sports Registration Form

Complete the form below to register your child for a Hermon Recreation sport!

Sport for which you are registering your child *
Child's Name * First Last
Age *
Grade *
Gender * Boy Girl
Shirt Size *
Mailing Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Physical Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone * - (###) - ### ####
Parent 1 Name * First Last
Parent 1 Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Parent 1 Cell * - (###) - ### ####
Parent 1 Email
Parent 2 Name First Last
Parent 2 Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Parent 2 Cell - (###) - ### ####
Parent 2 Email
Medical Information
Emergency Contact * First Last
Emergency Contact Phone * - (###) - ### ####
Relationship *
Insured? *
I/we the parents/guardians of the above named child give my/our approval to participate in any and all program activities including transportation to and from certain activities. We know that participation in recreational activities may result in serious injury and protective equipment does not prevent all injuries to children and hereby waive, release, absolve, indemnify and agree to hold harmless to the Hermon Recreation Department, the Town of Hermon, the organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.
I give Hermon Recreation permission to use my child's captured media images for advertising and special announcements * Yes No
By typing your name below you hereby acknowledge that the above information is truthful and accurate to the best of your knowledge. * First Last
Date * / MM / DD YYYY
If you have any questions or requests, please submit them in the box below.
Volunteers needed, please sign up!
Coach First Last
Phone - (###) - ### ####
Business Sponsor
Phone - (###) - ### ####

Sports Registration Form

Sports Registration Form

Medical Information

Volunteers needed, please sign up!