Winter Registration
2016-2017 Winter Sports Registration form
North Plainfield Recreation 93 Greenbrook Road
North Plainfield
NJ
07060
Recreation Hotline: 908 756-0247
Please Check One: must complete a form for each athlete per sport Basketball $45
View Adult Sports Online
Wrestling $55
Boys/Girls K – 8th Boys/Girls K-8th $1 will go towards the N.P.H.S. Scholarship Fund
Make checks payable to N. Plainfield Recreation
Drop Off Registration In Person Registration form and payment October 19, 20, 21 at Recreation office from 7-9 pm (93 Greenbrook Road) at Vermeule (614 Greenbrook Road) Season: December ’16 – March ’17 th Basketball Festival will Kick-Off the Season on December 10 , 2016
Online Registration Now Available @NP-Recreation.com Receive $20 Coupon to Dick’s Sporting Goods when registering online
Player Inform: Player’s Name:________________________________________Age:_________Gender:__________Grade:______ Player’s Address:______________________________________________________________________________
Home Phone:_____________________ Date of Birth:_________________ School:_______________________ Medical Information: Allergies / Medical Problems:___________________________________________________________________________ Circle if your child has any of the following:
EpiPen
Inhaler
Instructions: __________________________________
Circle your child’s level of experience playing on a team: Beginner Circle any travel teams your child plays on: Baseball/Softball
1 year Soccer
2 year 3+ years Basketball Other
Parent/Legal Guardian Information: Parent/Legal Guardian Name:____________________________ Signature:________________________________
Youth Sm Med Lg
Adult Sm Med Lg XL XXL
Youth Sm Med Lg
(Circle One)
YES, I will Coach! Your Name: _________________________________ Your Phone: _________________________________ Your Email: _________________________________
Adult Sm Med Lg XL XXL
(Circle One)
I have been: Fingerprinted to Coach Rutgers Safety Certified I am at least 18 years old
Code of Conduct: My player and I have read or will read the North Plainfield Parks and Recreation Code of Conduct policies located at www.np-recreation.com. We agree to abide by policies established by the North Plainfield Recreation Commission. _________________________________________________ (sign/date)
Amount Paid Check: _________ Cash: _________
Parents Cell Phone: ___________________ Parent/Guardian’s Email Address: ___________________________ Equipment/Uniforms: Basketball: All players will receive a shirt Wrestling: All wrestlers will receive a singlet
Picture/Video Release: I agree that by letting my child(ren) participate in a Borough of North Plainfield Recreation Department event they may use his/her picture for publication. __________________________________________________ (sign/date)
np-recreation.com
Liabilities Release: The undersigned participant or parent, if under the age of 18, assumes all risks involved and shall hold harmless the Borough of North Plainfield, the Recreation Commission, and its employees, from any and all liabilities. ____________________________________________________________ (sign/date)
North Plainfield Recreation Department Parks Commission 9/24/2016
North Plainfield Recreation 93 Greenbrook Road
North Plainfield
NJ
07060
Recreation Hotline: 908 756-0247
Please Check One: must complete a form for each athlete per sport Basketball $45
View Adult Sports Online
Wrestling $55
Boys/Girls K – 8th Boys/Girls K-8th $1 will go towards the N.P.H.S. Scholarship Fund
Make checks payable to N. Plainfield Recreation
Drop Off Registration In Person Registration form and payment October 19, 20, 21 at Recreation office from 7-9 pm (93 Greenbrook Road) at Vermeule (614 Greenbrook Road) Season: December ’16 – March ’17 th Basketball Festival will Kick-Off the Season on December 10 , 2016
Online Registration Now Available @NP-Recreation.com Receive $20 Coupon to Dick’s Sporting Goods when registering online
Player Inform: Player’s Name:________________________________________Age:_________Gender:__________Grade:______ Player’s Address:______________________________________________________________________________
Home Phone:_____________________ Date of Birth:_________________ School:_______________________ Medical Information: Allergies / Medical Problems:___________________________________________________________________________ Circle if your child has any of the following:
EpiPen
Inhaler
Instructions: __________________________________
Circle your child’s level of experience playing on a team: Beginner Circle any travel teams your child plays on: Baseball/Softball
1 year Soccer
2 year 3+ years Basketball Other
Parent/Legal Guardian Information: Parent/Legal Guardian Name:____________________________ Signature:________________________________
Youth Sm Med Lg
Adult Sm Med Lg XL XXL
Youth Sm Med Lg
(Circle One)
YES, I will Coach! Your Name: _________________________________ Your Phone: _________________________________ Your Email: _________________________________
Adult Sm Med Lg XL XXL
(Circle One)
I have been: Fingerprinted to Coach Rutgers Safety Certified I am at least 18 years old
Code of Conduct: My player and I have read or will read the North Plainfield Parks and Recreation Code of Conduct policies located at www.np-recreation.com. We agree to abide by policies established by the North Plainfield Recreation Commission. _________________________________________________ (sign/date)
Amount Paid Check: _________ Cash: _________
Parents Cell Phone: ___________________ Parent/Guardian’s Email Address: ___________________________ Equipment/Uniforms: Basketball: All players will receive a shirt Wrestling: All wrestlers will receive a singlet
Picture/Video Release: I agree that by letting my child(ren) participate in a Borough of North Plainfield Recreation Department event they may use his/her picture for publication. __________________________________________________ (sign/date)
np-recreation.com
Liabilities Release: The undersigned participant or parent, if under the age of 18, assumes all risks involved and shall hold harmless the Borough of North Plainfield, the Recreation Commission, and its employees, from any and all liabilities. ____________________________________________________________ (sign/date)
North Plainfield Recreation Department Parks Commission 9/24/2016
