Player Registration

Parent / Guardian Information

Full Name *

Email *

Phone *

Relationship to Child *

Street Address *

City / Town *

State *

ZIP Code *

Town of Residence * (used for in-town approval)

Player Information

First Name *

Last Name *

Date of Birth *

Grade

Child's Phone (optional)

School (optional)

Experience Level (optional)

Medical Notes / Allergies (optional)

Emergency Contact

Name *

Phone *

Relationship (optional)

Additional Contacts

Optionally add up to two more people authorized to pick up your child or be contacted.

Additional Contact 1

Full Name

Phone

Relationship

Email (optional)

Team Selection

Sport *

Team *

Select a sport first to see available teams.

Liability Waiver & Release

Town of Dixmont Recreation Program
Assumption of Risk, Release, and Emergency Authorization

By registering for a Town of Dixmont recreation program, event, clinic, league, practice, game, or related activity, I acknowledge and agree as follows:

1. Voluntary Participation
I understand that participation in recreational and athletic activities is voluntary. I am voluntarily registering myself, or the minor child named in the registration, to participate in the Town of Dixmont Recreation program identified in this registration.

2. Acknowledgment and Assumption of Risk
I understand that participation in sports, recreation, practices, games, travel connected with activities, and use of fields, gyms, playgrounds, and other facilities involves inherent risks. These risks may include, without limitation, falls, collisions, contact with other participants, coaches, volunteers, spectators, equipment failure, weather-related conditions, field or facility conditions, transportation-related risks, and other known or unknown risks that may result in personal injury, illness, disability, property damage, concussion, serious injury, or death.
I knowingly and voluntarily assume all such risks, both known and unknown, to the fullest extent permitted by law.

3. Release and Hold Harmless
To the fullest extent permitted by law, I, on behalf of myself and, where legally permitted, on behalf of the participating minor child and our respective heirs, personal representatives, and assigns, release, waive, and discharge the Town of Dixmont, its Recreation Department, officers, employees, volunteers, coaches, agents, committee members, officials, and affiliated participants from and against claims, demands, causes of action, damages, losses, or expenses arising out of or related to participation in the program or use of Town facilities or equipment, including claims arising from ordinary negligence.
This release is intended to be as broad and inclusive as permitted under Maine law and shall not be construed to release claims that cannot lawfully be released.

4. Responsibility for Medical Insurance and Fitness to Participate
I understand that the Town of Dixmont does not provide health, medical, or accident insurance for participants. I understand that I am solely responsible for maintaining any desired insurance coverage for myself or the minor participant.
I certify that I, or the minor child I am registering, am physically able to participate, or that I have consulted with an appropriate medical professional and accept any participation-related risks.

5. Emergency Medical Authorization
In the event of injury or medical emergency, I authorize the Town of Dixmont and its representatives to obtain or arrange reasonable emergency medical care for me or for the minor participant if I cannot be reached immediately. I understand that reasonable efforts will be made to contact the emergency contacts provided in the registration. I accept full responsibility for any costs of medical care, transport, treatment, or related services.

6. Rules and Conduct
I understand that participants and parents/guardians are expected to follow Town of Dixmont recreation rules, safety instructions, and standards of appropriate conduct. I understand that unsafe, disruptive, threatening, or abusive behavior may result in suspension or removal from the program without refund, subject to Town policy.

7. Photo / Media Consent
Photo and media consent is optional and may be accepted or declined separately using the checkbox provided on the registration form.

8. Parent/Guardian Representation for Minor Participant
If I am registering a minor child, I certify that I am the parent or legal guardian of that child, or otherwise have legal authority to complete this registration and consent on the child's behalf.

9. Severability
If any portion of this acknowledgment and release is found unenforceable, the remaining portions shall remain in full force and effect to the fullest extent permitted by law.

10. Electronic Acknowledgment
By checking the acknowledgment box and submitting registration electronically, I certify that I have read and understand this Assumption of Risk, Release, and Emergency Authorization, and agree to it voluntarily.

I have read and agree to the Assumption of Risk, Release, and Emergency Authorization *

I grant permission for photos/video of the participant to be used for Town promotional purposes (optional)