WILMINGTON RECREATION DEPARTMENT JR. BASKETBALL - 2015 The Junior Basketball co-ed program is designed to teach children in grades one and two the basics of the game. Skill development will be stressed although game situations and scrimmage play will be utilized as part of the learning process. Lowered baskets are used in this program. Each child will receive a team shirt. The program will take place in the Shawsheen Elementary School Gym on Saturdays from January 3 through February 7. Hourly sessions will run approximately 8:00 a.m. to 7:00 p.m. and your child will be assigned a different time each Saturday. To register, please submit the completed form below, accompanied by a $35 registration fee (cash or a check made payable to Wilmington Recreation). Registrations can also be mailed to Wilmington Recreation Department, Town Hall, 121 Glen Rd., Wilmington, MA 01887. Coaches will notify players of the time of their first game one week prior to the start of the program. Team shirts and schedules will be distributed at the first game. Registration deadline is Thursday, November 13. • • • There is a late fee of $10.00 per child after the registration deadline. Late registrations will be accepted based on availability. Once teams are full, names will be placed on a waiting list. A $10.00 processing fee will be charged for all refunds. There are no refunds after December 5, except for medical reasons. Coach requests cannot be honored. We will try to honor one reciprocal carpool request per player if noted on both players’ forms. ------------------------------------------------------------------------------------------------------------------------------------------------JR. BASKETBALL - 2015 $35 ________ Grades 1 & 2 NAME__________________________________ SEX 1 M 1 F DATE OF BIRTH ____/____/____ STREET_____________________________________________ HOME PHONE _____________________ SCHOOL_________________ GRADE 1 1 1 2 SHIRT SIZE (see samples) 1 YM 1 YL 1 YXL Check if applicable: 1 Team with sibling _____________ (Name) Please note: Only one reciprocal carpool request will be honored, and only if noted on both players’ forms. Notes: ___________________________________________________________________________________ THIS PROGRAM DEPENDS ON VOLUNTEERS. DO YOU WISH TO VOLUNTEER TO COACH? Note: All coaches are subject to a CORI check.  Form  Yes  No If yes, name: __________________________________ Preferred Phone #:____________________ Email address: FOR PARENT OR GUARDIAN: I hereby certify that the above named child is in good health and capable of participating in Jr. Basketball. I have read and understand the above and hereby grant permission for my child to participate. I hereby release the Town of Wilmington, its agents, servants and employees from any liability and/or responsibility which may arise from an accident or injury incurred during participation in JRBL. I understand that any falsification of this document and/or failure to abide by basic program rules and behavior expectations will lead to immediate dismissal from the program. _______________________________________ _________________________ Parent or Guardian’s Signature Date Attn: PARENTS/GUARDIANS: Please complete for your coach’s records: Child’s Name: _________________ Parent/Guardian: ___________________ Phone: _________________ Emergency Contact: ____________________ Relationship: ____________ Phone: _________________ Parent/Guardian Email address: (please print) _______________________________________________