Registration Form - West Fargo Park District

Registration Form
Mail to 601 26th Ave E, West Fargo ND 58078
Fax Registrations to: 701-433-5369
Drop off at the Park Office located at 601 26th Ave E.
Please
Plea
Pl
ease
e use
use a separate form for each participant. Forms can be found at wfparks.org.
Participant Name _________________________________________________________________________________________ Gender (M/F)_________
(First)
(Middle Initial)
(Last)
Address _______________________________________________________________City __________________________State________Zip_____________
Primary Phone ______________________________________ Cell Phone_________________________________Birth Date_______________________
School _____________________________________ Parent(s)/Guardian(s)_________________________________________________________________
Current Email Address (required)___________________________________________________________________________________________________
Participant(s) your child will be carpooling with: 1.)_______________________________________ 2.)______________________________________
Emergency Contact:________________________________________________________________________________________________________________
(Name)
Can you Volunteer Coach? Y / N
(Phone)
(Relationship to Child)
Name of Coach____________________________________________________________ Shirt Size_____
Code
Activity Name
Fee
Total Fees
*A current email address is required when
registering. Team schedules will be emailed
prior to the start of team activities and posted
at wfparks.org. We do not sell or lend your
personal information to any outside party.
Youth
Jersey or
T-shirt
S
M
Basketball
Shorts
S
M
Adult
L
S
M
S
M
Youth
L
XL
Adult
L
L
XL
Payment Method
(REGISTRATION NOT COMPLETE WITHOUT PAYMENT)
____Cash
____Check (Payable to West Fargo Park District)
____Visa
____MasterCard
____Discover
Credit Card #_____________________________________________ Exp. Date__________________ 3 Digit Security Code__________
Name on Card (Print)__________________________________________ Signature of Cardholder_____________________________________________
Waiver
I understand that the West Fargo Park District and/or activity sponsor does not provide medical insurance nor will the West Fargo Park District and/or activity
sponsor be responsible for any medical expenses. I hereby authorize Park District employees, activity coaches and instructors to act for me according to their
best judgement in any emergency requiring medical attention and hereby waive and release the West Fargo Park District, its employees, activity sponsors,
coaches, and instructors from any and all liability for any injuries. I also certify that my child(ren) or above listed participant(s) are medically fit to participate
in the above activity(s) and have health insurance. I know that my phone number may be given to coaches or instructors, and I realize that I will not receive
a refund unless I provide a doctor’s note. I know that photos of participants may be used by the Park District.
________________________________________________________________________________________________________________________
Parent/Guardian Signature (18 and older)
___________________________
Date