CLINTON PARKS AND RECREATION DEPARTMENT 201 Killingworth Turnpike, Clinton, CT 06413 (860) 669-6901 GIRLS SOFTBALL for GRADES 1-3 MONDAYS AND WEDNESDAYS AFTER SCHOOL – 3:00 PM - 5:00 P.M. Register Early th, Practices begin the week of April 20 weather permitting. th Games begin the week of May 4 . Season ends June 15th, 2015 (Pizza Party-Rain or Shine) Photo Day – Wednesday, May 6th, 2015 (Rain or Shine) Child’s Name: ___________________________________________________________________________ Grade: _________________Age: _________________ Date of Birth: _______________________________ Address: ________________________________________________________________________________ Parent: _______________________________Phone:_________________Cell:________________________ Email Address: ___________________________________________________________________________ Please Note: The majority of our communications are sent via email. Please print your email address clearly. Thank you. Doctor’s Name: _________________________________________Phone: ___________________________ SHIRT SIZES: Please Circle One: YM YL YXL Please indicate if your child has any severe illness or allergic reactions that we should know about below: ________________________________________________________________________________________ Name to call in case of emergency (other than yourself) below: ______________________________________Phone_________________Cell ________________________ Did you play on a P&R Softball team last year? YES or NO If yes, please indicate the following: Team: ___________________________________Coach:_________________________________________ Do you want to march in the Little League Parade (Saturday, April 25th) YES or NO (Little League Parade Rain Date: Sunday, April 26th) Do you want to march in the Memorial Day Parade (Monday, May 25th) YES or NO Would you be interested in Coaching or Assisting a Team? Parents Name: _________________________________________________ YES or NO I give permission for my daughter to participate in any and all Softball Activities. I understand that the Recreation Dept. will not be held responsible for any injuries as a result of participating in the Softball Program. I also understand that I must carry Accident (Medical) and Liability Insurance for my daughter. I understand the inherent risks of playing softball. You may also contact my child’s Doctor in an emergency if I cannot be reached. Parent/Guardian: _________________________________________Date:__________________ PLEASE RETURN THIS FORM AND FEE TO THE PARK AND RECREATION OFFICE BY Wednesday, April 1, 2015 Do NOT send this form Back To JOEL!!! FEE: $35.00 PER CHILD (Fee includes a T-shirt and Baseball Cap) Make your checks payable to the Clinton Park and Recreation Dept. Amount Rec’d.: ___________ Check/Cash #: ___________________ Date: ____________