INSTRUCTIONAL/YOUTH RECREATION BASKETBALL

The Fort Scott Recreation Youth Basketball Program is now being organized.   Boys and Girls in the K & 1st, 2nd & 3rd grade and 4th & 5th grades are eligible to participate.   The registration fee is $10 which includes a team shirt.   Deadline to register is Friday, October 7, 2005.  After October 7th, the fee will be $20.

Practice times will vary according to the each coach's schedule.   Games will be played on Tuesdays for the K & 1st grade and 2nd - 5th grade on Saturday mornings beginning in November of 2005.   Games will get over before Christmas allowing time before Upward Basketball in the Spring.   All participants will receive equal playing time.

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YOUTH BASKETBALL REGISTRATION

(Register at Buck Run Community Center)

NAME_____________________________________ADDRESS_________________________________

AGE______   BIRTHDATE___________________GRADE____________ (Please Circle)   BOY or GIRL

PARENT'S NAME ___________________ DAY PHONE_____________ _ HOME PHONE____________

Do you have a brother or sister in the same grade that will play in the same league?      Yes        No

If yes, Who?__________________.   No other request such as carpooling, friend or cousin will be accepted!

SHIRT SIZES:    (Check One)

                                                      YOUTH    S___M___L___                      ADULT   S___M___L___

Would you like to be considered as a Coach?___ Assistant Coach? ___ Coach if needed ___?

If so, please list name and phone #_________________________________________________________

Please list any medical concerns that the FSRC and/or coach should be aware of?____________________

_____________________________________________________________________________________

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PARENTAL CONSENT STATEMENT     Youth Basketball - 2005

The undersigned parent(s) and natural guardian(s) of ____________________, a minor, in consideration of his/her being permitted to participate in the Fort Scott Recreation Program, do hereby freely and voluntarily give my/our consent of such and participation hereby release the Fort Scott Recreation Program, Inc., its director, officers, employees, agents, any sponsors, organizers, or coaches from any and all claims or rights of action, which the undersigned or the said child may have or ever may have as a result of any act or omission of any such persons of the Fort Scott Recreation Program, Inc.   The undersigned recognizes that the child will be engaged in a sporting activity and that there are certain risks involved in such an activity, including the risk of personal injury, and the undersigned assumes the risk thereof.

Parent/Guardian Signature_____________________________Date_________________