Registration Fee: $50/player. Make Checks Payable to SPRD
Player Information
Player Full Name:__________________________ __________________________ _________________________
First Name
Middle Name
Last Name
Player Date of Birth: _________/_________/_________ Player Age (as of Aug. 1, 2014): ___________________
Month
Day
Year
Mailing Address: _____________________________________ _____________________ _____ _____________
Street/PO Box
Home Phone: ____________________
City
Gender: ___Male ___Female
State
Grade: ____
Zip
# of Yrs Played: ____
best reached number
Please List Any Medical Conditions: _______________________________________________________________
SELECT PLAYER SHIRT SIZE
________
________
________
________
________
________
________
YS (6-8)
YM (10-12)
YL (14-16)
AS
AM
AL
AXL
CHECK ONE
OF THE
FOLLOWING
Do you live in the:
 CITY
 COUNTY
PARENT/GUARDIAN INFORMATION
SPRD USE ONLY
HEIGHT: ___________ 30-YD DASH: ____________
PAYMENT INFORMATION
RECEIPT # ________________
RCVD BY: ______
CASH
CHECK # ___________
DEBIT/CC
Note: _________________________________________
FATHER
MOTHER
NAME (first and last)>>>>>>>>>>>>>>>>
ADDRESS (write SAME, if applicable)
CITY, STATE, ZIP
HOME / CELL PHONE (best reach number)
WORK / CELL PHONE
EMAIL ADDRESS (REQUIRED)
ARE YOU INTERESTED IN COACHING?
Starkville Park Commission (SPC) Parent/Guardian’s Permission (Covenant not to Sue)
I/We the parent(s)/guardian hereby give my consent for the above named child to participate in Flag Football in consideration of Starkville
Park Commission (SPC) allowing my daughter/son to participate in this activity, or any related activity, and for other good and valuable
consideration, I hereby covenant and agree not to sue SPC, or any employee, or coach hereof, and hereby release and forever discharge SPC,
or an officer, agent, employees, or coach hereof, from any and all claims, demands, rights and causes of action of whatsoever kind and nature
for any damages including bodily or personal injury sustain by my child and arising from his or her participation in such activity, sponsored
by SPC, including transportation to and from the activity. I authorize any official, employee, agent or coach of SPC associated with the
program to obtain, through a physician of its own choice, any emergency medical care that may seem to them to be necessary for my child. I
agree to allow SPC to use the likeness or picture(s) of my child on social media (Twitter, Instagram, Facebook) or other media outlets.
I HAVE READ & FULLY UNDERSTAND THIS FORM
__________________________________________________________________
Signature of Parent/Guardian
______________________
Date
SPORTSMANSHIP EXPECTATIONS
1. Participants, coaches, and spectators are expected to conduct themselves in an
appropriate manner at all times.
2. Participants, coaches, and spectators are expected to abide by the rules and regulations
of the sport in which they are involved.
3. Participants, coaches and spectators are expected to show respect for facilities,
equipment, sport officials, and all supervisors and SPRD personnel.
4. Participants, coaches, and spectators are expected to address game officials in a
respectful manner. All individuals should not use profanity, insulting or vulgar
language or gestures when addressing a game official, nor at any time attempt to
influence or object to an official’s decision.
SPORTSMANSHIP PENALTIES
1. Any individual who does not abide by the sportsmanship expectations set by the
Starkville Parks and Recreation Department may be subject to penalty.
2. Any individual ejected from a contest must leave the playing area immediately upon
notification of the supervisor.
3. Any individual shoving, striking, or physically abusing an official or supervisor will
receive and automatic suspension for the remainder of the season.
4. Any incident that is determined to be unsportsmanlike by a game official or supervisor
will be written up and reported to the Sport Coordinator.
5. Unruly coaches, players, or spectators may cost their team a forfeit if determined by the
official or supervisor in charge.
I have read and understand the above expectations.
_________________________________________
Print Full Name
_________________________________________
Signature
Comments/Requests:
These requests are taken into consideration, however, they are NOT guaranteed to be honored!
__________________
Date