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Program Registration Form

  1. Photography Release*

    I hereby grant permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials are the property of Campbell County Recreation Department and will not be returned. I hereby authorize Campbell County Recreation Department to edit, alter, copy, exhibit, or publish this photo for purposes of marketing programs and events. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Campbell County Recreation Department respects the privacy of all its program participants, and will not release the name of any participant. All measures will be taken to maintain security of all program participant identities. My signature on this form indicates that I have read this release and I fully understand the contents, meaning, and impact of this release

  2. Release *

    In consideration of the permission granted to me or my child by the Recreation Department of the County of Campbell, Virginia, to participate in this program, I hereby release and save harmless the County of Campbell, its officers and employees, from all actions, causes of action, damages, claims, or demands which I, my children, my heirs, executors, administrators, or assigns may have against the County of Campbell, and other described parties for all personal and property injuries known or unknown which may have incurred by participating in this activity. I, the undersigned, have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

  3. Parent's Code of Ethics*

    All Campbell County parents must agree to the Campbell County Recreation Department Code of Ethics for Parents. I hereby pledge to provide positive support, care and encouragement for my child participating in youth sports by following this Campbell County Code of Ethics for Parents: • I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, practice, or other youth sports event. • I will place the emotional and physical well-being of my child ahead of a personal desire to win. • I will insist that my child play in a safe and healthy environment. • I will require that my child's coach upholds the Campbell County Code of Ethics for Coaches. • I will support coaches and officials working with my child, in order to encourage a positive and enjoyable experience for all. • I will demand a sports environment for my child that is free from drugs, tobacco and alcohol, and will refrain from their use at all youth sports events. • I will remember that the game is for youth - not for adults. • I will do my very best to make youth sports fun for my child. • I will help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting with coaching, or providing transportation. • I will ask my child to treat other players, coaches, fans and officials with respect regardless of race, sex, creed or ability.

  4. Please note:

    When making a payment, please type the "ACTIVITY AND YEAR" into the section marked "REFERENCE #" so we may align your payment with the proper registration form. In addition, you must complete and submit a registration form for each child/participant for a program; however, only one payment for the total number of participants needs to be made after submitting the last participant's registration.

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  6. This field is not part of the form submission.