NON RESIDENT
Today’s Date: ___-___-___ Request
for Participation (must fill out
reverse also)
Child’s Name: _________________________________________ Birth Date: _____-_____-_____ Gender M or
F
Parents Names:
Mother___________________________
Father______________________________
Address: __________________________________City/Town_____________ZIP_________
Phone #:_____-_____-_____
Insurance Company____________________________ Plan ID #____________________________________
Grade in School: ___________
(During Sport) Parent Email Address _______________________________________________
===================Check Only One Below Per
Form========================
Spring
Boys Baseball ( )
T-Ball (6)_____,
7-8’s_____, 9-10’s_____, 11-12’s_____, 13-15’s_____,
16-18’s_____
Girls Softball ( ) T-Ball (5-6)_____, 7-8’s_____,
9-10’s_____, 11-12’s_____, 13-14’s_____,
15-19’s_____
Lacrosse ( )
Ages 8 - 14______
Cheerleading ( ) Must be entering Grade 2 in the fall.
Fall
Football ( ) Flag
(5-6)_____, Jr. Pee Wee(7-8)_____, Pee Wee (9-10)_____, Midget(11-13)_____
Soccer ( )
Ages 5-14
Winter
Basketball ( ) Ages 9-16
Wrestling ( ) Grades K-6th
FEES ON REVERSE SIDE
Notes:
|
Fees are as follows if Approved by Recreation Board: |
Non Resident |
|
|
$20.00 |
|
Athletic Association Fee |
$30.00 |
|
Recreation Board Fee: For Non Residents only and required for
each child in each sport registered per year |
$20.00 |
|
Total |
$70.00 |
|
|
|
Make Check Payable to
Take this form to the Recreation Board Meeting when requesting approval.
Bring Activity Fee Form if Applicable
------------------------------------------------------------Internal
Use Only Below-------------------------------------------------