CIA in the park

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CIA IN THE PARK - bASKETBALL AND FLAG FOOTBALL

Boys and Girls ages 7-12,
Join us at Goodyear Park on Parkwood (next to the Hospital)
for 3 on 3 basketball and flag-football
10am-1pm for a morning filled with fun, and competition…
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Parents and Guardians,
This is a family stay and watch event.
Please bring your chair, watch and cheer them on as they have a great time…

Please email any questions to:
[email protected] or 912-332-8000.

* Indicates required field

Parent/Guardian's Name: *

First

Last

Parent/Guardian's Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian's Email: *

Parent/Guardian's Cell Phone: *

Alt. Phone: *

Player One Name: *

First

Last

[object Object]

D/O/B (month,day & year) *

Gender: *

Male Female

Player two Name: *

First

Last

[object Object]

D/O/B (month,day & year) *

Gender: *

Male Female

Player three Name: *

First

Last

D/O/B (month,day & year) *

Gender: *

Male Female

ASTHMA (CHOOSE ONE) *

My child(ren) "DO NOT" have Asthma. My child(ren) "DOES HAVE" Asthma. I will print the "ASTHMA ACTION PLAN FORMS" and present pages one and two the first day of activities. I understand, for my child(ren)'s safety, my child(ren) will not be able to participate without "THE ASTHMA ACTION PLAN".

PLEASE IDENTIFY WHICH CAMPER(S) HAVE ASTHMA. IF NONE, PLEASE TYPE N/A. *

CLICK HERE FOR asthma DOCUMENTS

CONCUSSION DOCUMENTS *

I have read CIA's concussion documents to stay abreast of symptoms related to concussions concerning my child's health.

Click Here for Concussion Documents

PICTURES/VIDEOS: Throughout the year, there are occasions when CIA Sports Club will take pictures/videos of your child(ren) participating in activities. We may use, duplicate, broadcast, distribute, and display these pictures/videos in CIA publications, local newspapers, advertising or on websites maintained for CIA. Thank you in advance for your permission, support and understanding. *

I have read CIA's pictures/videos agreement and agree to allow my child(ren's) picture/video to be utilized in CIA publications, local newspapers, advertising or on websites maintained for CIA.

CIA DAY IN THE PARK Registration *

I HAVE READ AND FULLY UNDERSTAND THIS FORM. I, as parent or Guardian, hereby give my consent for my child(ren) to participate in activities and in consideration of CIA Sports Club allowing my child(ren) to participate in any related activities, and for other good and valuable consideration, I hereby covenant and agree not to sue CIA Sports Club, or any staff, member, or coach thereof, and hereby release and forever discharge CIA Sports Club, or any staff, member, or coach thereof from any and all claims, demands, rights and causes of action of whatsoever kind of nature for any damages including bodily or personal injury sustained by my child and arising from his or her participation in such activity, sponsored by CIA Sports Club, including transportation in such activity. I authorize any staff, member or coach of CIA Sports Club 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(ren). I agree to pay all associated cost.

Your application has been received. Thank you!

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