CITY OF MOSS POINT

DEPARTMENT OF PARKS AND

RECREATION
YOUTH SPORTS REGISTRATION FORM

Participant’s Name: ________________________ Date of Birth: _____________

Select One
Address: ____________________ City: _______________ State: _____ Zip:________
Football
Phone #:_____________ Alternate Phone #:_______________ Age: ______ $60

Parent’s Name: _______________________________________________ Cheerleading

$60
School: __________________________________________ Grade: _____
Basketball
(Circle One) $60
Previous Experience: YES NO Weight: __________
Girls Softball
Shirt Size: (Youth) XS SM MD LG XL (Adult) SM MD LG XL XXL $50

Pants Size: (Youth) XS SM MD LG XL (Adult) SM MD LG XL XXL Mossy Hoops

$40

Flag Football
$40
I hereby acknowledge that health and accident coverage, at the expense of the participant, are
required in all organized athletic activities and I also certify that my child is covered by
health and accident insurance issued by _____________________ Insurance Company. In
addition, I accept full responsibility for medical/hospital expenses
and other related expenses not covered by the required insurance for injury received by the above name individual
while participating in the athletic program. I do hereby hold harmless the City of Moss Point Parks and Recreation
Department, their agents and assignees of responsibility for any such injury or expenses and waive any and all
claims which may arise against them.

It is recommended that each child receive a physical examination and approval by a doctor before participation in
the sports program. Such medical examination would be at the expense of the participant and the option of which
medical doctor is chosen by the participant.

Once a player is placed on a team, he/she will remain on the team until he/she becomes ineligible by age.

NOTICE………. The Parks and Recreation Department issues a NO REFUND

Policy for Youth Sports.
My signature below attests that I have read, understand and agree with the terms and conditions and that I give
consent for my child to participate in the athletic program designated above.

D Signature of Parent/Legal Guardian: __________________ Date: ________

 FOR OFFICE USE ONLY

ation Fee Payment: $________ ___/___/___ Receipt No. _________

Birth Certificate
Insurance Information Registration Staff Initials: ________