Youth Sports Registration Form

You must receive a confirmation page.
If you do not receive a confirmation page, your child's registration form has not been received.


Please tell us the sport your child is registering for:

Please provide your child's name, address, and telephone number including area code:

First Name  
Last Name  
Middle Initial  
Street Address  
City  
Zip/Postal Code  
Home Phone  

Please provide the child's age and gender:

Sex Male Female

Please provide the child's current school grade:

Please enter your child's date of birth:

Date of Birth (mm/dd/yyyy)

Please provide the parent or guardian contact information:

Name
Work Phone  
Cell Phone  
E-mail

Please tell us the Elementary School district in which your child goes to school or lives:


If your home district is not available, what is your 2nd choice of an elementary school district:



Name of last season's coach:

Will you be willing to COACH?  
If yes, Please enter your name

    and your telephone number.

Please provide an emergency contact name and number.         

Emergency Contact Name:  
Emergency Contact Number:  


I understand the importance of following all rules and regulations relating to this activity, including the instructions of the person/or persons supervising this activity and/or the requirements of the person or entity responsible for the area where the activity is to take place. I agree to follow and comply with all such rules, regulations, instructions and/or requirements. I understand that it is important that I be in good physical condition when I agree in the activity, and understand that it is my responsibility to maintain an activity level that is compatible with my physical condition and skill level. I hereby expressly assume the risk of any physical injury or other loss that I might sustain as the result of participating in this activity and any transportation related thereto. I further understand that there may be risk of injury in traveling to and from the area where the activity will take place. I also expressly waive and covenant not to sue on any claim I might have against the County of Franklin, or any officer or employee of the County, or any volunteer, or the estate or representatives of such persons for any personal injury or loss that I might sustain as the result of engaging in any activity relating to this program whether caused by negligence, breach of contract, or otherwise: except that this waiver shall not apply to any claim I might have against the County (or its agents) for any such personal injury or loss I might sustain arising out of gross or wanton negligence of any such person or entity. I also give permission for my child to be photographed and used in any form of publication to promote Franklin County Parks & Recreation. I am also aware that these photos may be placed on the Franklin County Parks & Recreation website.


Parents Code of Ethics NYSCA Coaches training is offered seasonally to all youth sports coaches. In these trainings, youth coaches sign a Coaches Code of Ethics Pledge that states they will instill appropriate ethics while in their coaching position. Parents will also be held to a high standard of behavior to provide a positive environment for their child's sports experiences. Together as partners, we can provide a fun, safe and positive recreational program for all of the participants in the County. Please take time to read this pledge and return it with your child's registration form. This Parent's Code of Ethics Pledge MUST be signed and returned with your child's registration form before he/she will be eligible to participate! I hereby pledge to provide a positive support, care and encouragement for my child participating in youth sports by adhering to this Parent's Code of Ethics. 1. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, practice or other youth sporting event. 2. I will place the emotional and physical well being of my child ahead of a personal desire to win. 3. I will insist that my child play in a safe and healthy environment. 4. I will support coaches and officials working with my child in order to encourage a positive and enjoyable experience for all. 5. I will demand a sports environment for my child that is free of drugs, tobacco and alcohol and will refrain from their use at all youth sporting events. 6. I will remember that the game is for youth and not for adults. 7. I will do my very best to make youth sports fun for my child. 8. I will ask my child to treat other players, coaches, fans and officials with respect regardless of race, sex, creed or ability. 9. I promise to help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting with coaching and providing transportation.


By clicking the "Submit Form" button, you agree to being the parent or legal
guardian listed in the parent/guardian contact information section of this form.
 

After clicking submit, please save or print the next page that appears. This is your confirmation page.

Franklin County
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Rocky Mount, VA 24151
(540) 483-3030
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