RECREATION BASKETBALL REGISTRATION AND PAYMENT MUST BE REMITTED TO BYRAM RECREATION DEPARTMENT BY Wednesday, November 12 A recreation level program focused on skill and strategy development open to children in grades 2- 8. Grades 3 and up will have a practice and game schedule that includes travel to play against other Sussex County recreation programs. Grades 3 and up will receive a personal uniform to keep. Grades 7 and 8 may be mixed. Grade 2 is a clinic program that begins in January. Grades 3 – 8 begin in December. All grades continue through mid-March. Registrations received Nov 13 and afterwards will incur a $25 late fee and will be accepted only if there is room on a team. The registration fee includes facility fees, T-shirts for 2nd graders, uniforms for grades 3—8, balls, officials, league fees, coach’s training and background checks, site managers, and other equipment. For further information please call Byram Recreation at 973-347-2500 x160 or visit http://www.lenapehoops.com. Please use this form to register. Registration fee:Grades 3—8 $125.00 Registration fee: Grade 2—$45.00 Please submit total cost with your registration. TRAVEL BASKETBALL A highly competitive program for girls and boys grades 5-8 with games held throughout northern New Jersey. Tryouts are held Monday evenings in Oct—early Nov and a limited number of players are chosen for each team. Games and practices are held from November through March. Players will receive a uniform to use for the season. Coaches are needed for Travel Teams. Registration fee: $190.00 Please submit $125.00 with registration. You will be contacted with tryout schedule. Athletes who do not make the travel team, or is a travel team is not formed for the age bracket, this fee will become the registration fee for the Recreation League and is non-refundable. Lenape Valley Basketball Child’s Name_________________Gender _____ Address ___________________ Grade______ Byram Parks & Recreation Medical Form This form must be completed by a parent or guardian. Name: __________________________ DOB: ____ /____ /____ Today’s Date: ____ /____ /____ TO BYRAM TOWNSHIP AND THE INSTRUCTOR/COACH IN CHARGE: In the event, in your opinion, that my child/myself requires emergency treatment, you have my permission, and I hereby designate you as my agent, to call 911 for my child. Insurance Company: _______________________ ID#:_______________________________ Doctor: _________________________________________ Phone: _______ - _______ - ________ I hereby release you from any claim arising out of the doctor’s or EMS’s actions, and I assume and agree to pay the doctor’s charges for services rendered at the doctor’s or EMS’s discretion. Parent/Guardian/Participant Signature: ____________________________________________ Parent/Guardian/ Name: ___________________________________ Phone: ____ - ____ - ____ Please list below the names of relatives, neighbors or friends who may be contacted in case of an emergency: Name: __________________________________ Name: __________________________________ Address: _______________________________ Address: ________________________________ Town: ______________ Zip Code: ___________ Town: ______________ Zip Code: ___________ Phone: __________ - __________ - __________ Phone: __________ - __________ - ___________ Participant’s Medical Information: Allergies to food and/or medications: __________________________________________________________________________________ Are there any health conditions of which we should be aware? Explain: __________________________________________________________________________________ Town ___________________ DOB ________ Home Phone __________ Cell Phone _________ Email Address _________________________ Shirt Size: YM YL AS AM AL AXL Shorts Size (grades 3—8): YM YL, AS AM AL AXL ACKNOWLEDGEMENT & HOLD HARMLESS RELEASE FORM: I hereby grant permission for myself and/or my child to participate in Byram Township Recreation activities and assume all risks and hazards incidental to such participation. I waive and release all rights and claims for damages against Byram Township, its employees, officers, staff, sponsors and other participants for any and all injuries that may be suffered by the herein named minor or myself while participating in the program. I realize that my child’s academic responsibilities are a priority and will schedule his/her time appropriately. I understand that all fees paid are not refundable without a doctor’s note. I recognize that Byram has a set of rules and regulations, and I agree to conduct myself in accordance therewith and to exercise my influence where appropriate on those for whom I am responsible in order to encourage proper conduct and decorum. I also give permission for the Byram Parks and Recreation Department to make non-commercial use of any activity photographs or video of my child/myself. Signature: __________________________ Date: ____ /____ /____