Darlington Wellness Center

Youth Registration Form and Waiver of Liability

Name Date
Address DOB
City State Zip
Home Phone Cell Phone Work Phone
(Parent's)
Program Fee Paid Team

Programs (Check all that apply)

Beginners Weight Lifting Basketball (league/camps)
Volleyball (camps/drills) Volleyball League
Gymnastics Karate
Speed and Conditioning Kickball
Dodgeball Other (please specify)

 

Waiver of Liability

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. 
  
Print Name____________________________ 

Signature_________________________________Date ___________ 


If under 18,  parent or guardian must sign below. 
  
Signature of Parent/Guardian_________________________ Date_________ 
  
Print Name________________________________

 

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