First Name*

Middle Int.*

Last Name*

Birthdate*

Age*

Address*

Zip*

Home Phone:*

Cellular:*

Email:*

Please Select Sex:*

Male Female

School Child Attends:*

I/we the parent's of the above child hereby give my/our approval for his/her participation in any and all activities during the current season. I/we assume all risks and hazards incidental to the conduct of the activities including transportation to and from the activities. I/we do hereby release, indemnify and hold harmless the Kinston-Lenoir County Parks & Recreation Department, organizers, sponsors and the employees or any/all of them. In case of injury to my child, I/we hereby waive all claims against the Kinston-Lenoir County Parks & Recreation Department, organizers, sponsors or supervisors appointed to them.

**I/we release any responsibility from transporting my child to/from above activity
**I/we are in position to furnish a certified copy of the child's birth certificate if requested.

Your electronic signature below indicates your agreement with the above statements.

PARENTS SIGNATURE*

DATE*

SELECT THE SPORT YOU ARE REGISTERING FOR

Baseball

Select Age Group

TeeBall 8-U 10-U

12-U 15-U

Softball

Select Age Group

6U 8U 10U

12U 14U

Tennis
(Fee Required)

Select Age Group

8U 12U

18U

Track & Field

Previous Team:

Previous Coach:

Shirt Size:*

RECREATION DISTRICT (PLEASE SELECT ONE)

Select District*

Banks Contentnea/Savannah Fairfield Holloway LaGrange M.C. Freeman Moss Hill Pink Hill Southwood Other

PLEASE SELECT IF YOU WOULD LIKE TO VOLUNTEER AS A COACH OR SPONSOR A TEAM

Select One

I would like to volunteer as a coach

I would like to sponsor a team