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2. Please complet the online form below to submit your registration
4. Liability Waiver Release
   The undersigned in consideration of and as part payment for the right to participate in the activity (s) of the Beloit Parks and Recreation Department described below, hereby, acknowledge the existence of and assumes all risks connected with the activity (s) described below. The undersigned further release the City of Beloit and all person and entities participating in connection with or on behalf of the City of Beloit in activity (s) above from liability for any injury, harm or complication resulting from said participation. The Beloit Parks and Recreation Department reserves the right to dismiss or expel any person from our programs or facilities for behavior this is detrimental to the programs and facilities. This includes, but is not limited to conduct that constitutes safety hazards, physical abuse, mental abuse and failure to comply with City rules and regulations.
6. Contact Information
8. Parent's First Name*
9. Parent's Last Name*
11. Participant's First Name *
12. Participant's Last Name *
14. Gender *

    1. Male
    2. Female
15. Grade Level *
    -- Select One --First Second Third Fourth
16. Activity *
    -- Select One --Flag Football Soccer Basketball
18. T-Shirt Size *

    Youth T-shirt Sizes: Small 6-8, Medium 10-12, Large 14-16, Extra Large 18-20

    1. Small

    1. Medium

    1. Large

    1. X-Large
20. Address1*
22. City*
23. State*
24. Zip*
26. Home Phone Number
27. Cell Phone Number*
29. Email Address*
31. Volunteer Coaches are needed to make the Youth Sport Programs a success. Please Volunteer to support the youth in you community!
33. Would you like to coach/supervise? *

    1. Yes
    2. No
35. No refunds after the deadline date.
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field