Peewee Basketball Registration Form
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2010 YOUTH PEE WEE BASKETBALL REGISTRATION FORM The West Plains Parks and Recreation Department is currently registering students for Pee Wee Basketball. Eligible students must be in grades 3 through 12. The registration fee per child is $20.00. The deadline for entry is 5:00 p.m. December 4, 2009. Registration forms may be turned in at the Parks and Recreation Department between 8:00 a.m. and 5:00 p.m., Monday through Friday, or can be mailed to West Plains Parks and Recreation Department, 1135 West Broadway, West Plains, MO 65775. Any registration that is not received by the assigned deadline will be placed on a waiting list until a vacancy becomes available. The year 2010 season is scheduled to begin on January 9, 2010 with 3rd through 6th grades competing on Saturday, while 7th through 12th will compete on Monday evenings, beginning January 11, 2009. The Parks and Recreation Dept. will schedule a one-hour practice for each team weekly; however coaches may schedule additional practices. For further information please contact Len Jones at the Parks and Recreation Dept.(417)-256-7304
NAME:__________________________________ AGE:_________ HEIGHT:__________ DATE OF BIRTH:_________________________ CURRENT GRADE:________________ PARENT OR GUARDIAN:____________________________________________________ ADDRESS:_________________________________________________________________ HOME PHONE:__________________________ BUS. PHONE:______________________ PLEASE CHECK ON OF THE FOLLOWING FOR PLACEMENT PURPOSE:
PLAYED BEFORE ________
NEVER PLAYED_________
My signature below acknowledges to the West Plains Parks and Recreation Dept. that my SON/DAUGHTER (please circle one to indicate child’s gender) ____________________has my permission to participate in the city recreation program for the 2008/2009 season. Furthermore, I will not hold any participant, coach, official, or any other person(s) responsible in the case of accident or injury to my child. ________________________________ Parent/Guardian Signature * PARENTS * WOULD YOU BE WILLNG TO COACH? YES ____ NO ____ WOULD YOU OR YOUR COMPANY LIKE TO SPONSOR A TEAM? YES ____ NO ____
NAME:__________________________________ AGE:_________ HEIGHT:__________ DATE OF BIRTH:_________________________ CURRENT GRADE:________________ PARENT OR GUARDIAN:____________________________________________________ ADDRESS:_________________________________________________________________ HOME PHONE:__________________________ BUS. PHONE:______________________ PLEASE CHECK ON OF THE FOLLOWING FOR PLACEMENT PURPOSE:
PLAYED BEFORE ________
NEVER PLAYED_________
My signature below acknowledges to the West Plains Parks and Recreation Dept. that my SON/DAUGHTER (please circle one to indicate child’s gender) ____________________has my permission to participate in the city recreation program for the 2008/2009 season. Furthermore, I will not hold any participant, coach, official, or any other person(s) responsible in the case of accident or injury to my child. ________________________________ Parent/Guardian Signature * PARENTS * WOULD YOU BE WILLNG TO COACH? YES ____ NO ____ WOULD YOU OR YOUR COMPANY LIKE TO SPONSOR A TEAM? YES ____ NO ____
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