| 2010 ST. FRANCIS SUMMER CLASSIC REGISTRATION FORM | |||||||||
| PLAYER NAME | ____________________________ | MALE | FEMALE | ||||||
| ADDRESS | ____________________________ | DOB | ______________ | ||||||
| ____________________________ | HEIGHT | ______________ | |||||||
| SCHOOL | ____________________________ | WEIGHT | ______________ | ||||||
| PARISH | ____________________________ | GRADE (NOW) | _______ | ||||||
| MOTHER ___________________ | FATHER____________________________ | ||||||||
| PHONE NUMBER FOR CONTACT | ____________________________ | ||||||||
| EMAIL ADDRESS FOR CONTACT | ___________________________________ | ||||||||
| OTHER CONTACT IN CASE OF EMERGENCY___________________________ | |||||||||
| PHONE NUMBER FOR CONTACT | ___________________________________ | ||||||||
| PLAYING EXPERIENCE/TALENT LEVEL | |||||||||
| ________________________________________________________________ | |||||||||
| ________________________________________________________________ | |||||||||
| MEDICAL INSURANCE COMPANY/CARRIER__________________________ | |||||||||
| CONSENT, CERTIFICATION, AND WAIVER OF CLAIMS | |||||||||
| In consideration of my child's participation in the SFDS Summer Classic, I, the undersigned parent/guardian | |||||||||
| of the child above, certify that the information on this form is correct, and I waive al claims for damages I may have | |||||||||
| against SFDS, the Summer Classic, its director, coaches, and other staff, for any injuries suffered by me or my child. | |||||||||
| I atest that my child is physically fit for participation in the SFDS Summer Classic. I have read and understand | |||||||||
| the Summer Classic rules and regulations, and agree to abide by them. I promise to participate as a player, coach, or | |||||||||
| spectator in accordance with these rules and the principles of good sportsmanship. | |||||||||
| SIGNATURE | ____________________________ | DATE________________ | |||||||
| MAIL COMPLETED AND SIGNED APPLICATION WITH CHECK PAYABLE TO: | |||||||||
| ST. FRANCIS SUMMER CLASSIC | PO BOX 940703 | ROCKAWAY PARK, NY 11694 | |||||||
| FEES FOR PARISHIONERS OF ST. FRANCIS DE SALES | |||||||||
| GRAMMAR SCHOOL | $60.00 | HIGH SCHOOL | $75.00 | ||||||
| FEES FOR ALL OTHERS | |||||||||
| GRAMMAR SCHOOL | $65.00 | HIGH SCHOOL | $80.00 | ||||||
| APPLICATIONS ARE ACCEPTED FROM APRIL 15 - MAY 15 | |||||||||
| AFTER MAY 15 ALL APPLICATIONS MUST INCLUDE A $25 SURCHARGE | |||||||||
| AND ARE ACCEPTED AT THE DISCRETION OF THE DIRECTOR | |||||||||
| SPECIAL REQUESTS MAY BE MADE BUT WILL NOT NECESSARILY BE ACCOMMODATED | |||||||||
| REQUEST:_______________________________________________________ | |||||||||
| PLEASE NOTE IF YOU OR YOUR CHILD WOULD LIKE TO COACH, VOLUNTEER OR WORK | |||||||||
| ________________________________________________________________ | |||||||||
| ________________________________________________________________ | |||||||||
| FOR OFFICIAL USE ONLY | |||||||||
| DIVISION | __________________ | CHECK # | _________ | AMOUNT | _________ | ||||