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2. PARTICIPANTS NAME*
   ALL CHILDREN MUST HAVE A BIRTH CERTIFICATE ON FILE WITH OUR DEPARTMENT
3. ACTIVITY*
5. CONFIRMATION NUMBER*
   YOU GET A CONFIRMATION NUMBER BY PAYING THROUGH OUR ONLINE PORTAL. YOU MUST PAY BEFORE FILLING OUT THIS FORM
6. AGE (AS OF CUT OF DATE)*
7. BIRTH DATE*
   BIRTH DATE
8. GENDER*

   1. MALE
   2. FEMALE
10. PARENT(s)/GUARDIAN(s)*
11. PHONE*
12. PHONE 2
14. CITY*
15. MAILING ADDRESS*
16. ZIP *
18. TOWN RESIDENT?*

    1. YES
    2. NO

    A TOWN RESIDENT IS DEFINED AS ONE WHO LIVES INSIDE THE CITY LIMITS OF BENSON OR WHO OWNS PROPERTY OR A BUSINESS INSIDE THE CITY LIMITS AND PAYS TAXES TO THE TOWN. A BENSON ADDRESS DOES NOT NECESSARILY CLASSIFY YOU AS A RESIDENT
19. PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE)
21. EMAIL ADDRESS*
    IF NO EMAIL ADDRESS IS GIVEN THEN YOU WILL NOT BE REGISTERED.
22. SHIRT SIZE*
    -- Select One --YXS (2-4)YS (6-8)YM (10-12)YL (14-16)ASAMALAXLAXXL
23. INTERESTED IN COACHING?

    1. YES
    2. NO
24. INTERESTED IN BEING A SPONSOR?

    1. YES
    2. NO
26. PARENT/ GUARDIAN SIGNATURE*

    1. I ACCEPT
    2. I DO NOT ACCEPT

    AS A PARENT/GUARDIAN OF THE ABOVE NAMED PARTICIPANT, I UNDERSTAND THAT IN SPORTS ACTIVITIES THERE ARE INCIDENTS OF ACCIDENTS AND INJURY. I VOLUNTARILY ALLOW MY CHILD TO PARTICIPATE IN THESE ACTIVITIES. I HAVE READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS. I RELEASE AND AGREE TO HOLD HARMLESS THE BENSON PARKS & RECREATION DEPARTMENT, THE TOWN OF BENSON, AND ITS AGENTS FROM ANY CLAIMS ARISING OUT OF INJURY TO MY CHILD. I ALSO ACCEPT RESPONSIBILITY FOR MY ACTIONS, AS WELL AS, THE ACTIONS OF MY CHILD AND WILL BE RESPECTFUL OF THE DECISIONS MADE BY THE OFFICIALS AND/OR THE COACHES.
28. PARENTS CODE OF ETHICS*

    1. I ACCEPT
    2. I DO NOT ACCEPT

    Ø I will place the emotional well-being of my child/children ahead of my personal desire to win. Ø I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, practice and other youth events. Ø I will insist that my child play in a safe and healthy environment. Ø I will provide support for coaches and officials working with my child to provide a positive and enjoyable experience for all. Ø I will demand a drug and alcohol free sports environment for my child/children and agree to assist by refraining from their use at all youth sporting events. Ø I will remember that the game is for children and not adults. Ø I will do my best to make youth sports fun for my child/children. Ø I will treat all other coaches, players, fans and officials with respect regardless of race, creed or ability. Ø I will promise to help my child/children enjoy the youth sports experience within my personal constraints by assisting with coaching (when applicable), being a respectful fan, providing transportation or whatever else I am capable of doing. Ø I will refrain from the use of any foul language or obscene gestures before, during or after the game. Ø I will show the utmost respect to the opposing teams and officials at all times, including before, during and after the game.
30. ATHLETIC WAIVER AND RELEASE OF LIABILITY (OVER 18 READ BEFORE SIGNING)

    1. I ACCEPT
    2. I DO NOT ACCEPT
    3. n/a

    In consideration of being allowed to participate in any way in The Town of Benson, Benson Parks and Recreation or other Town of Benson Depts. Youth and/or Adult athletic programs, related events, classes, activities and/or trips the undersigned acknowledges, appreciates, and agrees that: 1) The risk of injury could be significant and while particular rules, equipment, and personal discipline may reduce the risk, risk of serious injury does exist and: 2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, even if arising from the negligence of the releasees or others and assume full responsibility for my participation; and 3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS BENSON PARKS AND RECREATION, their directors, officers, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lesser of premises used to conduct the event (RELEASEES), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from negligence of the RELEASEES or OTHERWISE, to the fullest extent permitted by law. HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
32. ATHLETIC WAIVER AND RELEASE OF LIABILITY FOR PARTICIPANTS OF MINORITY AGE (UNDER 18 AT THE TIME OF REGISTRATION)*

    1. n/a
    2. I ACCEPT
    3. I DO NOT ACCEPT

    In consideration of being allowed to participate in any way in The Town of Benson, Benson Parks and Recreation or other Town of Benson Depts. Youth and/or Adult athletic programs, related events, classes, activities and/or trips the undersigned acknowledges, appreciates, and agrees that: 1) The risk of injury could be significant and while particular rules, equipment, and personal discipline may reduce the risk, risk of serious injury does exist and: 2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, even if arising from the negligence of the releasees or others and assume full responsibility for my participation; and 3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS BENSON PARKS AND RECREATION, their directors, officers, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lesser of premises used to conduct the event (RELEASEES), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from negligence of the RELEASEES or OTHERWISE, to the fullest extent permitted by law. HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent allowed by law.
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