2017 FIRST GRADE BOYS BASKETBALL REGISTRATION

Program Starts:  Tuesday, November 7th @ Wahpeton Community Center (304 5th St So)

Schedule: Tuesday & Thursday, 5:45pm – 6:30pm @ Wahpeton Community Center. Runs through December 14th. Please carry tennis shoes into the gym.

Cost: $20.00

1st Grade Head Coach/Coordinator: Justin Erickson
Adult assistant/team coaches are needed for 1st grade.

Please read this form carefully and be aware that in registering yourself or your minor child/ward for participation in the above program, you will be waiving and releasing all claims to injuries you or your child/ward might sustain arising out of the above program.

I recognize and acknowledge that there are certain risks of physical injury to participate in the above program and I agree to assume the full risk if any such injuries, damages or loss regardless of severity which I or my child/ward may sustain as a result of participating in any activities connected or associated with any such program. I waive and relinquish all claims that I, my insurer, or my child/ward may have against the Park Board and its officers, agents, servants and employees from any and all claims from injuries, damages or loss which I or may child/ward may have or which may accrue to me or my child/ward on account of my participation of my child/ward in the above program.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE DETAILS AND WAIVER AND RELEASE OF ALL CLAIMS. *
Player's Name*
Parent/Guardian Name*
Grade:*
Parent Phone*
Alternate phone:
Email Address*
Address:*
T-Shirt Size:*
Any medical information we need to be aware of?
Are you willing to help coach? Provide name and phone number:
Fee:
 $ 
 . 
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