Bladen County North Carolina

 

STEPS to completing the ON-LINE REGISTRATION

1. Complete on-line registration form (below).
2. Check the box to indicate compliance with the Release/Waiver Agreement.
3. Click the Submit button.
4. After on-line registration form has been submitted, please click to pay on-line.
5. THANK YOU!!

 

Important Information:

Participants are not registered until payment is received!

Online Registration will close at 5 PM on the last day of registration!

 Out of County Registrations will be added after all Bladen County Residents if space allows. 

Send Birth Certificate to eclrogers@bladenco.org

 


Select Sport:

Please make sure to choose the correct age group for your child! 
 
 Soccer - Age as of August 1, 2024
 

PLEASE SUBMIT A COPY OF YOUR CHILD'S BIRTH CERTIFICATE TO THE PARKS AND RECREATION OFFICE!

*Select Sport:
Tot Soccer - ages 3-4
Soccer - ages 5-6
Soccer - ages 7-9
Soccer - ages 10-12

Participant Information
*Name:
*Address:
*City:
*State:
*Zip:
*County:
*Date of Birth:
Select one:
Female
Male
Mother's Name:
Mother's Cell Phone:
Do you receive text msgs?:
Yes
No
Father's Name:
Father's Cell Phone:
Do you receive text msgs?:
Yes
No
E-mail:
Are you interested in coaching?:
Yes
No
New or Last Season''s Team:
School Currently Enrolled::
Emergency Contact Name:
Emergency Contact Phone:
*Shirt Size - Choose one.:

Release/Waiver Agreement

In return for my child being allowed to participate in the selected Bladen County Parks & Recreation program, I release and agree not to sue the Bladen County Parks & Recreation, and their employees, sub-contractors, sponsors, agents and affiliates from all present and future claims that may be made by the participant or me, my family, estate, heirs or assigns for property damage, personal injury or wrongful death arising as a result of the participant's participation in the program and caused by the ordinary negligence of the parties listed above, whenever, wherever or however the same may occur. i understand and agree that those listed above are not responsible for any injury or property damage arising out of the program, even if caused by their ordinary negligence. I understand that participation in the program involves certain risks, including, but not limited to, serious injury. I am voluntarily allowing the participant to participate in the program with knowledge of the danger involved and agree to accept all risk of such participation. I certify that the participant is in excellent physical health, and may participate in strenuous and hazardous physical activities, including the selected program.  Permission is granted for the participant to receive emergency medical treatment if needed. I also agree to indemnify and hold harmless those listed above for all claims arising out of the participant’s participation in the program and all related activities.  I agree to let the parties use the participants name and likeness free of charge in any manner and for any purpose without compensation to the participant or me.  I understand that this document is intended to be as broad and inclusive as permitted by the laws of North Carolina and agree that if any portion of this Agreement is invalid, the remainder will continue in full legal force and effect.  I further agree that any legal proceedings related to this waiver will take place in Bladen County, North Carolina.  I am of legal age and am freely signing this Agreement.  I have read this form and understand that by signing this form, I am giving up legal rights and remedies.  I represent that I am a parent/legal guardian of the participant named above and I agree that the terms of this agreement are binding on me and on the participant.

Coronavirus / COVID-19 Warning & Disclaimer

Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Bladen County Parks and Recreation programs or leagues or accessing Bladen County Parks and Recreation facilities could increase the risk of contracting COVID-19. Bladen County Parks and Recreation in no way warrants that COVID-19 infection will not occur through participation in Bladen County Parks and Recreation programs or leagues or accessing Bladen County Parks and Recreation facilities.

*Parents or Legal Guardian Signature:
I have read the Release/Waiver Agreement.


* - denotes required field