Summer Youth Team Registration | East Coast Panthers

Username^*

Password^*

Password must be at least 7 characters long.

Enter password again^*

Password must be at least 7 characters long.

Player First Name^*

Player Last Name^*

Gender^*

Date of Birth^*

Grade Going Into^*

Height

Weight

Jersey Size^*

Shorts Size^*

Parent First Name^*

Parent Last Name^*

Email^*

Cell Phone^*

Emergency Number^*

Address^*

Street Number

Street Address

City

State

Country

Zip Code

Program

Medical Alerts/Conditions^*

Terms & Conditions^*

As a participant in the above program, I recognize and acknowledge that there are certain risks of physical injury. I agree to assume the full risk of any injuries, damages or loss which I or my child may sustain as in result of such participation. I further understand that the Town of Somers does not provide medical coverage and it is my responsibility to provide appropriate coverage. I agree to waive and relinquish all claims and hold harmless the Town of Somers Parks & Recreation, its officers, agents, and employees from any and all claims.

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