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FLAG FOOTBALL REGISTRATION

  1. COAB logo

  2. FLAG FOOTBALL REGISTRATION FORM

    Registration is for ages 5-12, $10 per child. Please pay registration fee by cash, money order or check. Register at the Recreation Dept. during office hours 8 am - 4 pm (excluding 12 -1 pm) or the Baker Center 9 am - 4 pm. Call 904-247-5828 for further information. All games will be played at Donner Park beginning mid-October.

  3. communications regarding games and meetings will be via email

  4. Please contact this person if the listed parent above is not available:

  5. Does the above named child have medical insurance?*

  6. Agreements:

    I hereby give my child permission to participate in the City of Atlantic Beach Recreation Program. I give permission for my child to be treated at a medical facility in case of an emergency I authorize the City of Atlantic Beach to use photographs of my child for advertising purposes.

  7. Signature Waiver

    The APPLICANT shall indemnify, defend and hold harmless the City of Atlantic Beach, its officers, employees and agents from any and all losses, costs, expenses, claims, liabilities, actions, or damages, including bodily injury and personal injury liability for injuries to any person or persons or damage to property arising at any time during and/or arising out of, or in any way connected with APPLICANT'S use of CITY/PUBLIC property, unless solely caused by the gross negligence of willful misconduct of the City, its officers, employees or agents.

  8. If Digital Signature, type in full name and Driver's License number

  9. OFFICE USE ONLY:

    Paid $ _________ Receipt # _________ Cash ______ Check # ______ Other _______

  10. Leave This Blank: