1. education
2. school

BASKETBALL LEAGUE
WEEK 1
WEEK 2 - 7
Dates
Location
Activity
Time
Tuesday 1/13/15
Park View
Skill Development
5:00 - 6:30pm
1/20/15 - 2/24/15
Park View
Skill Development
Rotating time schedule of either a
& Games
5:00pm or 6:30pm practice / game.
If you are interested in coaching, please contact us at the Cudahy Recreation Department. Weekly practice plans will be
made available and we need your fun and leadership to help teach kids the great game of basketball.
T-Shirt Size
Registrant First / Last Name
School
Age & Grade
Youth: 6-8 10-12 14-16
Fee
Adult: S M L XL
Parent Name: __________________________________________ Signature:____________________________________________ Date:__________________
Address ___________________________________________________________________City ____________________________________ Zip
Phone Number ________________________________Alternate # _______________________________________Email
CREDIT CARD (Circle): VISA Mastercard Discover
Card # _______________________________________________________
Exp Date _______________________________ V-Code ___________
Card Holder Name _________________________________________
Signature ____________________________________________________
PAYMENT INFORMATION:
Check # ______________ Cash ________________ Charge ________________
Total Amount Paid _________________
Checks Payable To: Cudahy Rec Dept.
I the above signed or parent/legal guardian of the individual(s) named above do hereby understand that I have registered the individual(s) named herein to participate in the aforementioned activity (ies) and I further agree to
indemnify and hold harmless the Cudahy Community Education and Recreation Department and the Cudahy School District along with all its employees, officers and agents from and against any and all liability. I understand
that neither the Cudahy School Board nor the Cudahy Community Education and Recreation Department assumes liability for payment of medical-hospital expenses which may be incurred by myself or the person on this form
while participating in this activity, but said liability will be assumed by myself. In addition, I understand that the requested programs indicated above, like any activity, have some inherent risk involved. Furthermore, the
individuals named herein are in good physical condition appropriate for the stated activity (ies) and that participants must assume full responsibility for injuries incurred while taking part in an activity. No accident insurance is
provided by the Cudahy School District nor the Cudahy Community Education and Recreation Department. Participants who do not have medical-hospital insurance coverage are encouraged to purchase this coverage from
their own insurance source. I further understand that the Cudahy Community Education and Recreation Department is not responsible for lost or stolen articles. I have read and fully understand this agreement, and furthermore
agree to the registration and related department policies, including the right to use my or my child’s photograph or image with or without my or my child’s name, both single and in conjunction with other persons or objects
for any and all purposes including, but not limited to, private or public presentation, advertising, publicity, promotion and social media relating thereto. If under 18 years of age, this form must be signed by a parent/legal
Submit your registration form and fee either in-person, by mail, online, or drop it off in our secure drop box
located outside the front entrance of the Administration Building at 2915 E. Ramsey Avenue, Cudahy, WI 53110
If you have questions call us at 414-294-7435 or visit us online at: www.cudahy.k12.wi.us/community/