Registration Form

REGISTRATION DEADLINE: December 19th, 2011

Wood County Recreation Commission

Winter Volleyball

2012 Registration Form
Participant Name____________________________________________________
Address ___________________________________________________________
Phone ___________________________   Cell ____________________________
Grade ___________   School __________________________________________
Shirt Size (circle one):     Youth L         Adult S         Adult M       Adult L        Adult XL
Parent Name (please print)_____________________________________________
Email _____________________________________________________________
For your child to participate in Wood County Recreation programs for the current season, this form MUST be signed and returned to the Program Coordinator prior to participating.

I give permission for my child, named above, to participate in the WCRC Winter Volleyball Program. It is clearly understood and agreed that Wood County Recreation Commission, its sponsors, and all persons connected with this program will not be held liable in the event of injury to my child.

Medical Information Release: I agree OR do not agree (circle one) to authorize the Wood County Recreation Commission staff, coaches, or medical persons to share information pertaining to injuries or health problems concerning my child to address proper care in the event of injury or sickness.
Parent Signature ___________________________________________________Date____________

Please return form ASAP to:              Wood County Recreation Commission
                                                       Attention CC Hardman
                                                       P.O. Box 1306
                                                       Parkersburg, WV 26102

Or Fax to: CC Hardman, Program Coordinator @ 304-424-7334

Please Note: This is a first come, first serve program. Waiting lists are not uncommon for this program. Your child cannot participate or be placed on a team until $40 registration fee is received, or other arrangements have been made. Checks must be written to Wood County Recreation Commission (WCRC). Thank You!