Cottage Grove, WI

Step One

Parent/Guardian Full Name
Street Address
City
State
Zip Code
Village of Cottage Grove:
1. Resident
2. Non-Resident
Home Phone
Cell Phone
Work Phone
Email
Continue

Step Three

I would like to volunteer as coach. Full name:
Coaches Shirt Size
I would like to volunteer for:
1. Head Coach
2. Assistant Coach
Late fee:
Registration is not guaranteed after program deadlines. A $10 late fee will be added to all late registrations.
Release of Liability / Photo Release
I understand that the above activities I have registered for may have an element of hazard or inherent danger and I take full responsibility for my actions and/or the actions of my children. I agree to hold harmless the Village of Cottage Grove, its employees, and contractual instructors from any and all liability, loss, cost, or expense that I may incur while participating in any of the above programs. I hereby give consent for emergency medical treatment in the event it is needed. In addition, I give my permission to have my photo and/or my child’s photo taken during the above events for the purpose of publicity.
I understand that the above activities I have registered for may have an element of hazard or inherent danger and I take full responsibility for my actions and/or the actions of my children. I agree to hold harmless the Village of Cottage Grove, its employees, and contractual instructors from any and all liability, loss, cost, or expense that I may incur while participating in any of the above programs. I hereby give consent for emergency medical treatment in the event it is needed. In addition, I give my permission to have my photo and/or my child’s photo taken during the above events for the purpose of publicity.
eSignature
(Must be over 18)
Date
Date
Concussion Awareness Waiver - Wisconsin Act 172
I have reviewed Cottage Grove Park and Recreation’s Concussion Awareness Information and I agree that if it appears that my child may have sustained a concussion or head injury that he/she is to be removed from any program until such time a trained medical professional can examine them and approve their return to play, pursuant to Wisconsin Act 172 relating to concussions and other head injuries. In such case, I understand I am to provide written clearance from a trained medical professional for my player to return to the activity for the Village of Cottage Grove. I have read and fully understand the statement regarding concussions.
I have reviewed Cottage Grove Park and Recreation’s Concussion Awareness Information and I agree that if it appears that my child may have sustained a concussion or head injury that he/she is to be removed from any program until such time a trained medical professional can examine them and approve their return to play, pursuant to Wisconsin Act 172 relating to concussions and other head injuries. In such case, I understand I am to provide written clearance from a trained medical professional for my player to return to the activity for the Village of Cottage Grove. I have read and fully understand the statement regarding concussions.
eSignature
(Must be over 18)
Date
Date
Please make checks payable to Village of Cottage Grove.
No confirmation for programs is sent without a self-addressed, stamped envelope.
Cash
Check Number
Amount Received
Date Received
Date Received
Received by:

Leave This Blank:

Print Only | Go Back

Form Center

Search Forms:

Registration Form

Steps

Step One

Participant Information

Step Three

Contact

Helpful Links

Using This Site