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PRUMC Sports and
Recreation
- Registration Form
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Peachtree Road United Methodist Church Sports, Recreation and
Life Enrichment,
3180 Peachtree Road NW,
Atlanta, GA 30305
(404) 266-2386,
Fax-(404) 266-0063 |
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(Please complete, print, sign and then mail, fax or drop off with payment) |
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Register To:
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Season: |
Year: |
1st
time with us? |
Sport/Activity:
or fill in:
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Participant Name:
PRUMC Member:
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Email Address
(Required):
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Birth Date:
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:
Age:
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Address:
City:
State:
Zip Code:
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Home Phone:-
Work Phone:-
Cell Phone:
-
School:
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Preferences: (Practice Day
/Time/Coach)
(No Guarantees) |
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Payment Information:
(Registrations will not be processed without payments) |
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Payment Type:
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Credit Card: |
Expiration Date: / |
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Credit Card Number:
Amount: $ |
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Signature
_________________________________________, Date: ___________ |
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If participant is under 18, please
complete below: |
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Mother's Name:
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Father's Name:
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Email Address:
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Email Address:
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Work Phone:
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Work Phone:
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Cell Phone:
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Cell
Phone:
- |
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(When finished please print, then sign and mail, fax or drop off with
payment)
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WAIVER OF LIABILITY AND RELEASE: I recognize that there are inherent risks involved in sports and fitness
activities. In consideration of the services provided, I hereby release and hold harmless, Peachtree Road
United Methodist Church (PRUMC) and its Department of Sports, Recreation and Life Enrichment and its
Directors, employees, and agents from any and all liability for injuries, including those resulting in
death, and illnesses incurred while participating or attending any event or in any facility of
PRUMC. By signing this document, the participant or legal guardian
confirms that he or she has authority to sign, has read the entire document, and has
understanding that the document waives certain rights of the person signing or
the participant. Signature
____________________________________________, Date: _________
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