PRUMC Sports and Recreation 

Tball, Baseball, & Soccer Registration Form

Peachtree Road United Methodist Church Sports, Recreation, & Life Enrichment

 3180 Peachtree Road NW, Atlanta, GA 30305
(404) 266-2386, Fax-(404) 266-0063

(Please complete, print, sign and then mail, fax or drop off with payment)

Register To:

Season:    Year:   1st time with us?

Sport/Activity: or fill in:

Participant Name:   PRUMC Member:
Email Address (Required):  
  Birth Date: Sex:       Age
Address: City: State:        Zip Code:
Home Phone:- Work Phone:-  Cell Phone:  -   

School:

Preferences:  (Practice Day/Time/Coach)   (No Guarantees)

Would you like to make a donation to the E. Rivers PTA ?  If, so please enter amount:   $
Payment Information: (Registrations will not be processed without payments)

Payment Type:   

Credit Card:    Expiration Date: /
Credit Card Number: Amount $
Signature _________________________________________, Date: ___________
If participant is under 18, please complete below:
Mother's Name: Father's Name:
Email Address: Email Address:
Work Phone: - Work Phone: -
Cell Phone:   - Cell Phone:  -

(When finished please print,  then sign and mail, fax or drop off with payment)

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: ______