Town of Southampton Activities

New Registration

  1. Participant is the same as above
  2. Grade:*
  3. How did you hear about this program? Please place a to which category (or categories) apply to you:*
  4. Street, City, State, Zip
  5. I give permission for my child (ren)**

    I give permission for my child to attend the Town of Southampton Youth Bureau’s F.A.S.T. program from Sept 2022-Dec 2022 at the Flanders Youth Center, 655 Flanders Road. I hereby shall release liability, waive any claims against, indemnify, defend and hold harmless the Town of Southampton, its officers, employees, contractors, agents and representatives from and against any and all demands, liabilities, losses, damages, expenses (including reasonable attorney’s fees) and judgments relating to or arising from my child’s participation in the Town of Southampton Youth Bureau’s F.A.S.T. program. I certify that my child’s health and physical condition are appropriate for participation in these physical activities. In the event of a medical emergency and I cannot be reached, I authorize the Town of Southampton Youth Bureau staff to seek emergency medical treatment. I also consent to photographs being taken of my child, understanding they may be used for promotional purposes.

  6. Leave This Blank: