2015 Levant Recreation Basketball/Cheerleading Registration
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2  015 Levant Recreation
Basketball/Cheerleading Registration Child Name _ Basketball ___________ Cheering _____________ (Please Check one) Child Name _________________________ Age _____ Grade______ Boy_____Girl______
Medical InformationDoes your child have a medical condition? ____, if so, list condition_____________________Emergency Contact____________________Relationship___________Phone _____________Is your child insured?______Insurance Carrier_______________Policy Number___________ Family Doctor___________________Phone_______Hospital preferred___________________Team InformationChilds Shirt Size – (please circle one) – Youth Small/Youth Medium/Youth Large/Youth XL (6/8) (10/12) (14/16) (18/20) Would you like to volunteer? (please circle one) – Coach/Asst. Coach/ Referee – if yes, Please put name and phone number of person volunteering.________ __________________________________________________________________ I the parent/guardian of the above listed child, give my approval to participate in the Levant Basketball/Cheerleading activities. I understand that participation in recreational activities may result in injury and protective equipment along with close supervision do not prevent all injuries to children, and hereby do not hold the Town of Levant Recreation Department, organizers, sponsor, supervisors, volunteers, or participants responsible, whether the result of negligence or any other cause. Signature ________________________________________________ Date_____________ |