Transcript Fitchburg Recreation Dept. Boys 7th and 8th Grade

2010-2011
Name: _______________________________________________________________
Address: _____________________________________________________________
City: _________________________________________________________________
Phone: _______________________________________________________________
School: ______________________________________________________________
Grade:
3rd 4th 5th 6th 7th
Age: _____________
8th
Date of Birth: ______/______/______
Are you a new or returning player? New: ______ Returning: ______
* For returning players ONLY: Last year’s team:
________________________________
* If she is moving up from WNBA (3rd-5th) to Collegiate (6th-8th), please mark off
you are a NEW player and put WNBA under last years team.
Please accept the above named person for participation in the above named event. I
am aware of the risks inherent with this activity, and release the sponsors from
responsibility for any and all liability. I have determined the nature of the planned
activities and feel this participant is of sufficient age, ability, and discretion to
participate. I also agree that the participant is at the discretion of the City of Fitchburg
Recreation Department. Violation of the league rules and regulations could result in
removal from the current team for the remainder of the season.
______________________________________
Parent or Guardian Signature
For Official use only:
Date: ____________
Fee: $50PD _____NPD _____
____________
Date