Slide 1

Report
North Carroll Recreation Council
BASKETBALL
2009 Registration Form
Mail to: NCRC Basketball, 3020 Crown Circle; Manchester, MD 21102
Checks Payable to: NCRC Basketball
 Please Circle One 
TRAVEL
INTRAMURAL
All participants in Recreation Council Activities must complete this form and have it signed by a parent or guardian before a child can play.
PLEASE PRINT NEATLY
Child’s Last Name
Child’s First Name
Street
MI
City/Town
Date of Birth
Age
Grade (2009-2010)
Zip Code
Male/Female
Father’s first name (last name if different)
Mother’s first name (last name if different)
Home Phone
State
Cell or Work Phone
Height (approx): feet
inches
T-Shirt Size
Please be specific: Youth s, m, l, xl, or Adult s, m, l, xl
Email Address
Years Experience:
Played Travel or AAU in the past?
Special Health Concerns
Please circle any days you are unable to practice. We will
do our best to help, but sometimes we cannot accommodate.
Mon
Tue
Wed
Thu
____
grade clinic/intramural
No
If yes, how many years?
Fri
Payment Information – Please check one.
____ Clinic grades K and 1
NCRC Member $30.00
2nd
Yes
Non-Member $35.00
NCRC Membership #
NCRC Member $45.00
Non-Member $50.00
____ Intramural
NCRC Member $45.00
Non-Member $50.00
____ Boys Travel
NCRC Member $180.00
Non-Member $185.00 (submit Intramural Fees only)
____ Girls Travel
NCRC Member $150.00
Non-Member $155.00 (submit Intramural Fees only)
Any activity involving motion or physical orientation and response involves a personal risk of injury, over-exertion or stress. The undersigned
acknowledges that the Recreation Council does not provide any registrant medical or hospitalization insurance whatsoever, and hereby waives
any and all claims against the Recreation Council and the Bureau of Recreation and Parks or any other person affiliated with the Recreation
Council program for injuries sustained while watching or playing games, traveling to and from games, or participating in any leisure time activity.
I understand that the participant is subject to the Council rules of conduct.
REFUND POLICY: No refunds shall be issued after December 1, 2008.
For Program Use Only
Fee Paid: $_________Rec’d by: ________
Date: ______ Cash _____ Check #_______
Evaluation (circle):
YES
NO
Signature of Parent or Guardian
Are you interested in:
____Coaching ____Team Mom/Dad ____ Sponsoring a Team

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