Beverly Recreation Online Youth Registration Form

   Please fill out ALL required fields. Forms that are not properly completed may affect your registration status.

   Completion of this online registration form is not a guarantee that space is available in this program or that your child has obtained a spot.

   Please do not use this form to register for Summer Camp or Evening Enrichment.

* = required fields

Household Information
*Child's Full Name:
*Street Address:
*City, State, Zip: ,
*Home Phone:
  Gender: Male      Female
*Date of Birth (mm/dd/yy):
*Grade in September '16:
*Registering Guardian's Email
*Please Confirm Email:
*Guardian #1 Name:
*Guardian #1 Phone:
  Guardian #2 Name:
  Guardian #2 Phone:
*Emergency Contact Person:
*Emergency Contact Phone:
Fall Programs
*Program Title: *

*Start Date: *

  Additional Comments:

Waiver of Damages and Release of Claims of Minor Child
I, the parent or legal guardian of a minor child, in consideration of his/her use of property belonging to the City of Beverly, and/or his/her participation in programs, leagues or events sponsored by the City of Beverly, and being aware of the risks associated with such use or participation, hereby release and discharge the City of Beverly, its agents and employees from any and all claims for personal injury or other damages that I might have as such parent or legal guardian, now or in the future, and from any and all claims that my said child may have now, or may acquire in the future, as a result of personal injury or damages that he/she may sustain as a result of his/her participation in any Beverly Recreation Department program, league or event. I agree that pictures taken in connection with the program or event may be used for future promotional purposes. Registration by phone signifies acceptance of the above listed Waiver of Damages.

*Please acknowledge your understanding and acceptance of the above waiver with a check here: