Anna Maria Island Community Center
Sport Registration Form


Please fill out the form below. If you plan to make your payment at the Community Center, just print out this form and bring it with you. If you want to mail a check, print out the completed form and send it along with your check. If you want us to put your payment on your charge card, submit the completed form and the office will call you for further information (do not put your credit card number on the form). You also have the option to pay online via our PayPal account. If you check this option, we will email you an invoice with a link to PayPal where you can make your payment.

Parent or Guardian Information: (* denotes required fields)
*Name 
*Street 
*City  *State  *Zip 
*Home Phone  Cell Phone  Work Phone 
*Email 

*Race
 Black/African-American
 Asian/Pacific Islander
 White/Caucasian
 American Indian/Eskimo
 Other
*Ethnic Group
 Hispanic
 Haitian
 Bi-racial
 Other
The above information is required for County Records.   Thank you.


Current Youth Programs (Please note that no registration will be accepted without payment)
*Child's Name *Date of Birth (dd/mm/yyyy)
We offer a discount of $5.00 for each additonal child in the same family


Upcoming Programs (Check interest and we will send you an email when registrations are accepted)
Name Contact Email
SOCCER
SOCCER CAMP
ROLLER HOCKEY
BASKETBALL
BASKETBALL CAMP
LITTLE LEAGUE


Please advise us of any special instructions or needs regarding health of participant.


*Emergency Contact:      *Phone:  

  • I hereby give the Anna Maria Island Community Center permission to take pictures of me and/or the subjects mentioned in this registration form, and to put the finished pictures of the Island Community Center’s website. I understand that these pictures will be accessible to anyone with Internet access and may be used in promotio0nal settings; however no names of subjects will be published without written authorization.
  • I also authorize AMICC and local newspapers to take pictures of my child and understand that these photos become the property of AMICC and/or the newspaper.
  • I also am aware that my child/s record and all records of Anna Maria Island Community Center may be reviewed by Manatee County (we are funded by the County) for audit purposes.

Waiver for Participation

In consideration of your accepting my/our registration fee, I hereby, for myself, my dependent(s) and minor children, and our executors and administrators, waive and release any and all rights and claims for damages I or my dependent(s) or minor children have or may have against Anna Maria Island Community Center and it’s representatives, successors, employees, contractors, or volunteers (collectively AMICC) for any and all injuries or death suffered by myself, my dependent(s) or minor children at any activity sponsored or monitored by AMICC, held upon its property, or through the use of its equipment. If I or my minor children or dependent(s) should suffer and injury, illness, or death while participating in an activity, I authorize AMICC instructors to use their sole discretion in having me or my dependent(s) and minor children transported to a medical facility and I take all responsibility for this action, including costs. I authorize the medical facility to render any emergency treatment deemed necessary. Also, I understand that no refunds are given unless the activity is canceled or a doctor’s release is presented. I understand that this release is a full and final release of all claims of any nature whatsoever for myself, my minor children or dependents including but not limited claims arising due to the sole joint, contributory, concurrent or gross negligence of AMICC. I understand that this release includes my minor children and I represent that I am the authorized guardian for my minor children.

I have read the above and agree I have read the above and disagree




Payment Options to print out completed form and send (or bring) along with your payment:
Cash (Print out form and bring it with you) Check (Print out form and send along with check )
Print out completed form and send (or bring) along with your payment



Please make checks payable to:    Anna Maria Island Community Center

Anna Maria Island Community Center
P.O. Box 253
Anna Maria, FL 34216


About Us | Annual Report | Board of Directors | Capital Campaign | Endowment Trust | Staff | Volunteer
Family Support | Adult Programs | Youth Programs | Sports | Tennis Program
Membership | Sports Registration
Fundraising | Current Events | Calendar