5th-7th Tip-Off Squad Registration

Due By Sat Dec 15th Turn in @ Bidarki

Name:___________________________________ Age/Grade: ______________ /_____________ Parent/Guardian:______________________ Contact #:______________________________ Email:__________________________________

I give permission for _______________________________________ to participate in 5ht-6th grade Basketball at Bidarki Recreation Center. I understand the risk of injury involved with my childs participation in this activity and use of Bidarki Recreation Center. I hereby waive and release the City of Cordova/Bidarki Rec. Center, their agents, instructors, volunteers, and employees for any and all injuries my child may incur while participating directly and/or indirectly in any of the activities occurring at Bidarki Recreation Center. I also understand that there is no insurance provided by the City of Cordova while attending or participating in any of the activities at the Bidarki Recreation Center.

Parent/Guardians Signature: ___________________________________Date:_______

________________________office use_________________ Membership Type (please circle one): xFAMILY x CORPRATE x YOUTH x DROP-IN x Drop-in & corporate must pay $20 program fee Payment type: ________ Staff Authorization:________