Rockport Recreation Department

Rockport Recreation Department Registration Form Youth Basketball All children in grades 3, 4, 5 & 6 are eligible to participate in the 2017-2018 Youth Basketball Program. The program will take place on Fridays and Saturdays beginning November 3rd and continuing through January 27th, 2018. The cost of the program is $75. There are scholarships available, please make checks or money orders made payable to the “Town of Rockport”. Please mail forms and checks to 37 Broadway, Rockport, MA 01966. If interested in coaching, or if you have questions please call 546-1309 or email [email protected]. Game Schedule is TBA. Grades 3-4 9:30-10:30 Skills & Drills Grades 5-6 10:30-11:30 Skills & Drills Name_________________________________________________________________________ Age___________________________________________________________________________ Grade_________________________________________________________________________ Address________________________________________________________________________ Parent(s) or Guardian(s) Name______________________________________________________ Phone_________________________________________________________________________ Email__________________________________________________________________________ Emergency Contact Name & Number_________________________________________________ Allergies (please list) _______________________________________________________________ Shirt Size: Adult: S M L XL

Youth: M L

I give my child permission to participate in the Rockport Youth Basketball Program. I free the Town of Rockport from any liability in case of injury. _____________________________ Parent/Guardian Signature

____________________ Date

I give my child permission to be photographed for the town web site. No names will be used. _____________________________ Date

____________________Parent/Guardian Signature