HICKORY GROVE UNITED
Please
print:
_________________________________________________________________________ Girl: ____ Boy:
____
Child’s First Name Last
Name
____________________________________________________________________ Check
all that apply:
Street Address
Member _____
Non-Member_____
____________________________________________________________________ I would like more
City State Zip information
about HGUMC____
____________________________________________________________________ Registration
E-mail address Home Work Requirements
1 - Completed form
____________________ __________________________ _______________ 2 – Registration Fee
Child’s Home Phone # Date of Birth Current
Age 3 - Birth
certificate copy
_____________________________________________________________________________________________
Father’s Name Cell/Work
# Mother’s Name Cell/Work #
Medical Information about the child:
Medications regularly taken:
Reason for taking medications:
Allergic reactions: Bee Sting:
___________ Penicillin:
__________ Other:
Any specific activities to be
restricted?
Other health information:
I, the undersigned parent or legal
guardian of the above named child, hereby gives approval to his or her
participation in any and all of the activities of the program during the
current season. I assume responsibility
for the transportation of my child to and from activities. I further understand that neither the
participating church nor the league in which the
candidate participates, carries medical insurance and in the event my child is
injured during any activity related to church or league play, I am solely
responsible for any medical bills incurred. I understand that my child will be
ineligible to practice and play in this sports program until a copy of the
birth certificate is provided, a completed registration form is on file and
registration fees have been paid. Misrepresentation of a child’s age or birth
date will result in his or her suspension from the league. Each participant
must sign the player’s code of conduct attached to this form or available for
download from the Internet.
I have provided accurate medical information on my
child and understand that medical expenses incurred while participating in this
sport are my responsibility.
Parent or Guardian Signature:
________________________________________________Date: ________________
FEE AMOUNT DUE WITH REGISTRATION: Registration After March 1*
T-Ball (ages
5-6 years old) $50 $60
Baseball/Coach Pitch $85 $95
Make
checks payable to HGUMC Recreation. *If
available
$5 discount per child if two or more children are
participating in same sport.
FIANCIAL ASSISTANCE IS AVAILABLE. YOUR
REQUEST WILL BE KEPT CONFIDENTIAL.
Shirt Size: (Please check one)
Youth ____ S
____ M ____ L ____ XL
Adult ____ S
____ M ____ L ____ XL
____ XXL
All coaches and players participating in sports with
Player’s Code of Conduct:
As a team member representing
HGUMC, I will:
Do my best to conduct myself in a
Christian-like manner at all times. Show respect for all coaches, umpires,
officials and team members. Not use profanity or display a bad attitude. Give
my best to my coach and team during all practices and games. Take care of any
uniform or equipment issued to me. Do my best to be on time for all practices
and games. Keep my ball fields clean by putting all trash in the trash bins. I
understand that if I fail to abide by this contract, my coach has the right to
restrict my playing time as the consequence for violating this contract. If
violations continue, the coach has the right to dismiss me from the team.
Player’s Signature: Date:
Parent’s
Signature: Date:
(if player is under 18 years of age)
The recreation department at
Please check the
volunteer opportunities that interest you:
__________
Coaching Youth Sports __________
Officials
__________
Coaching Adult Sports __________
Scorekeepers
__________
Interested in helping with a team but not as a Head Coach __________ Concessions- gym or fields
__________
Individual Sports Coordinator
Concession stand work at:
__________
Recreational
questions should be directed to Recreation Ministries at the main church number,
704-537-4686, extension 45.
Recreation Ministries,
email rec@hgumc.com