2016 Basketball Registration Form For Boys and Girls - 1st-6th Grades
2016 Basketball Registration Form Longview Heights Baptist Church Recreation Ministry Church Office: (662) 895-1900 FMC Office: (662) 890-4911 Andrew Kappenman, Recreation Minister ([email protected]) Sarah Merritt, Recreation Asst. ([email protected])
For Boys and Girls - 1st-6th Grades
Player’s Last Name: _____________________________ First Name: _______________________ M. I. : ________ Street Address: _______________________________________________________________________________ City: _____________________________________________ State: __________ Zip Code: __________________ Home Ph: ______________________ Cell: ______________________ Birth Date: _____________ Gender: _____ Grade in School (Fall 2015): ________ Age: _______ Primary E-Mail:____________________________________ Father’s Name: _____________________________________Mother’s Name: ______________________________ Home church: _________________________________________________________________________________ List any relevant medical problems: ________________________________________________________________ Jersey Size: YXS / YS / YM / YL / AS / AM / AL / AXL 1st Preference for Practice Night: Mon Tue Thur Fri 2nd Preference for Practice Night: Mon Tue Thur Fri Carpool Request: (only same age/grade) __________________________________________________ (other player must also list your child as their carpool request) Participant Registration Fees - 2016 Season $55.00 -- Must be received before 11/15/15
No Applications will be accepted after 11/15/15
Registration: FMC Office - Monday-Thursday 8:00am-5:00pm; Friday 8:00am-Noon West Event Center - Sundays/Wednesdays Make checks payable to Longview Heights Baptist Church * Cancellation Policy -- Refund requests must be made before uniforms are ordered. Refund requests should be made by contacting Sarah in the Recreation Office. ([email protected] or 662-890-4911). Calendar: August 9 - Nov. 15 November 14 November 16 November 30 Dec 21-Jan 3 January 4 January 9 February 27
Registration Skills Evaluations (9am-Noon) Make-Up Evaluations (6-8pm) Practices begin this week No Practices Scheduled Practices resume First Game Day Last Game/Player Recognition
~~~ Office Use Only ~~~ Date Rec _______________ Amt.Rec_______________ Cash Check
Check Number: _____________
Received by: __________________________________
Permission to Play / Hold Harmless I, the parent or guardian of the minor registrant, agree that the registrant and I will abide by all the rules of Longview Heights Baptist Church Recreation Ministry. Recognizing the possibility of physical injury associated with sports and in consideration for the church accepting the registrant for its sports program and activities, I hereby release, discharge and/or otherwise indemnify LHBC, their employees and associated personnel and volunteers against any claim by or on behalf of the registrant as a result of the registrant’s participation in the LHBC Recreation Ministry. I have read the cancellation policy and agree to its terms. Signature:_____________________________________ Date: _____________________________
For Boys and Girls - 1st-6th Grades
Player’s Last Name: _____________________________ First Name: _______________________ M. I. : ________ Street Address: _______________________________________________________________________________ City: _____________________________________________ State: __________ Zip Code: __________________ Home Ph: ______________________ Cell: ______________________ Birth Date: _____________ Gender: _____ Grade in School (Fall 2015): ________ Age: _______ Primary E-Mail:____________________________________ Father’s Name: _____________________________________Mother’s Name: ______________________________ Home church: _________________________________________________________________________________ List any relevant medical problems: ________________________________________________________________ Jersey Size: YXS / YS / YM / YL / AS / AM / AL / AXL 1st Preference for Practice Night: Mon Tue Thur Fri 2nd Preference for Practice Night: Mon Tue Thur Fri Carpool Request: (only same age/grade) __________________________________________________ (other player must also list your child as their carpool request) Participant Registration Fees - 2016 Season $55.00 -- Must be received before 11/15/15
No Applications will be accepted after 11/15/15
Registration: FMC Office - Monday-Thursday 8:00am-5:00pm; Friday 8:00am-Noon West Event Center - Sundays/Wednesdays Make checks payable to Longview Heights Baptist Church * Cancellation Policy -- Refund requests must be made before uniforms are ordered. Refund requests should be made by contacting Sarah in the Recreation Office. ([email protected] or 662-890-4911). Calendar: August 9 - Nov. 15 November 14 November 16 November 30 Dec 21-Jan 3 January 4 January 9 February 27
Registration Skills Evaluations (9am-Noon) Make-Up Evaluations (6-8pm) Practices begin this week No Practices Scheduled Practices resume First Game Day Last Game/Player Recognition
~~~ Office Use Only ~~~ Date Rec _______________ Amt.Rec_______________ Cash Check
Check Number: _____________
Received by: __________________________________
Permission to Play / Hold Harmless I, the parent or guardian of the minor registrant, agree that the registrant and I will abide by all the rules of Longview Heights Baptist Church Recreation Ministry. Recognizing the possibility of physical injury associated with sports and in consideration for the church accepting the registrant for its sports program and activities, I hereby release, discharge and/or otherwise indemnify LHBC, their employees and associated personnel and volunteers against any claim by or on behalf of the registrant as a result of the registrant’s participation in the LHBC Recreation Ministry. I have read the cancellation policy and agree to its terms. Signature:_____________________________________ Date: _____________________________
