Today’s Date:_______________
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 Note:
$20 Late Uniform fee will be added to registration
Wrestling ( ) Grades K-6th if previous uniform not return within 2 weeks
of established
hand in date at end of season.
Resident Fees:
|
$20. 00 |
AA Fee (per sport). Paid
for each child in each sport registered per year |
|
$20. 00 |
|
|
$40.00 Total |
Total Amount Due |
|
|
MAKE CHECK PAYBALE TO |
Volunteer Info: You will be required to volunteer 3 hours per child per sport.
Are you interested in Coaching? Yes or No