RECREATION BASKETBALL

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: ____ /____ /____