STERLING RECREATION BASKETBALL 2022 - 2023 *REGISTER ONLINE at STERLINGREC.COM*
Player Name : _________________________________________
Home Phone: _______________________ Work/Cell Phone: ____________________________
Mailing Address:_____________________________________ E - Mail: __________________________
Birth Date:_______ Grade ___
Age ___
Gender: M / F
Height ______
CIRCLE T - shirt Size: Youth: M L
Adult: S M L XL
Known allergies or other pertinent medical information______________________________________
Parent name (s) __________________________________________________
Emergency Contact: ____________________________________ Phone Number:___________________________
Division I - IV $100 by November 1st, Division V - $100 by December 1 Late Fee - $10 after December 1 Family cap - 3+ children $250.00
I (name) ________________________am interested in Coaching ____ Assistant Coaching____
Contact me at phone _________________________ Email ______________________
Waiver In consideration of this application, I or my child hereby release, discharge and/or indemnify the Recreation Director, Recreation Committee, Staff, and/or Volunteers, the Town of Sterling and its ’ elected officials of any liability related to the operation of this program. I hereby give my consent for emergency medical care prescribed by a licensed Doctor of Medicine or Doctor of Dentistry. It is possible that pictures will be taken during classes. I agree that pictures taken during program hours could potentially be used for promotional purpose. I understand that all participants of the Recreation programs will be respectful of anyone employed by or contracted by the Recreation Department when participating in Recreation sponsored programs. I understand that the Recreation Department will not be responsible for any or all personal items brought to any Recreation Dept. sponsored programs. I understand when I or a designated person signs my child out from a Recreation sponsored program, the responsibility of my child and his/her belongings are my sole responsibility Signature _______________________________________ Date______________ Signature of participant (or parent/guardian if under 18) WAIVER MUST BE SIGNED TO PARTICIPATE IN PROGRAMS
*No special request will be honored *All players must register through the Recreation Department, not with the coach *Teams will not be selected until the required number of division coaches is available CHECKS PAYABLE: Town of Sterling MAIL TO: Sterling Recreation, 1 Park Street, Sterling, MA 01564
For office use only:
Date Received____________
Check # ___________
Amount $______________
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