The City of Wellston, Ohio
RECREATION DEPARTMENT
Universal Player Application

Print this application on your computer, fill it out, and return to one of these businesses:
Brodigan's Sporting Goods, 7 South Ohio Av, Wellston, Ohio 45692
Ron's Trophies, 414 East C St, Wellston, Ohio 45692
Place your check or cash and the application in a sealed envelope.
All player fees are $25
All applications MUST BE returned by the registration deadline posted on this website.

SPORT: __Soccer __Basketball __Volleyball __ Baseball __ Softball __ Cheerleading

Name of Participant_________________________________________________

Address__________________________________________________________

Home Phone_________________________ Birthday __________ Age________

E-mail address______________________________________ Grade_________

Shirt Size: Check One: ___ YOUTH 6-8 ___YOUTH 10-12 ___YOUTH 14-16

___ADULT Small ___ADULT Medium ___ ADULT Large ___ ADULT Extra Large


WAVIER AND RELEASE

I/We ____________________________________ (parent/guardian name) certify the
above information is true. We will not hold the Wellston Recreation Department
responsible for injury or death to any participant of a Wellston Recreation Department
sponsored sport and/or activity.

The Wellston Recreation Department does not provide medical insurance for any
player or participant. Insurance coverage must be provided by the parent and/or guardian.
Team membership is selected by a roundtable draft of eligible participants.
All parents must sign and adhere to the Parent's Code of Conduct.
Checks are payable to the Wellston Recreation Department.
All fees are non-refundable and all decisions and rule changes are final.

I/we agree to the terms and conditions stated above.

Parent/Legal Guardian signature_______________________________________

Today's date______________________________

Thanks! We'll contact you soon.
Form R2
WRD-05/rbc