Plymouth Recreation Form -One form per individual-

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Our Contact Info:

Phone: (603) 536-1397

We ask that all participants in our programs complete this form for safety, liability, and data tracking reasons. Thank you for your cooperation!

Email *

I am a: *

Resident/Taxpayer of Plymouth

Non-Resident/Non-Taxpayer of Plymouth

What program(s) are you signing up for? *

Adult Pickleball

Adult Walking Club

Plymouth ELITE Travel Basketball Clinics/Tryout

SAU 48 Middle School Laser Tag Plymouth Night 3/6/25

Other:

Required

Participant Information:

Name:

DOB:

Preferred Gender:

Current Grade: (if applicable)

School: (if applicable)

Allergies/Limitations *

If participant is under 18 years of age

Parent/Guardian Name:

Phone:

Email:

Other Parent/Guardian Name:

Phone:

Emergency Contact:

Name:

Phone:

Mailing Address: *

Phone Number: *

Please Type Your Name and Today's Date to Sign Our Release of All Claims:

In consideration of the permission granted for the participant named above to take part in the above named Recreation program, I hereby release for myself and my heirs, the Town of Plymouth, its agents, employees, volunteers and other program participants from all actions, damages and claims that may result in personal injuries and property damages. I recognize there may be inherent dangers in participating in Recreation programs which may present a strain on the body and its parts, and furthermore, I represent that to the best of my knowledge the participant is in proper physical condition to allow participation. I therefore assume all risks associated with participation in said program. I understand that, in case of injury or illness, Recreation will attempt to contact the parent/guardian listed above. In the event of a medical emergency, I consent to the participant's treatment by a medical doctor and I agree to pay all costs associated with said treatment, including transportation to a medical facility. I, the undersigned, have read this release and understand all its terms and implications and I hereby execute this release of my own free will and with full knowledge of its significance.

Send me a copy of my responses.

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