| Name | Date | ||
| Address | DOB | ||
| City | State | Zip | |
| Home Phone | Cell Phone | Work Phone |
|
| Program | Fee Paid | Team | |
 |
Men’s Basketball (summer/winter) | |
Tae Kwon Do (all year) (tournament) |
|
Co-ed Kickball (summer) | |
Dodgeball (league/tournaments) |
|
Men’s Volleyball (winter) | |
Aerobics (classes) |
|
Women’s Volleyball (winter) | |
Personal Training (sessions) |
|
Co-ed Volleyball (summer/winter) (rec league / power league) |
|
Volleyball Tournaments ( 1 day tournament) |
|
I hereby understand that to the best of my knowledge, I have no physical restrictions that would prohibit my participation in the program registered for on this form.
Furthermore, I acknowledge that like all physical activity, this program may inherent some risk and I release the Darlington Wellness Center, and City of Darlington of any financial responsibilities due to injuries received while participating in this program. Signature_________________________________Date ___________
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