Register at the PAL Recreation Office, 1250 Maple Avenue
908-226-7714
Monday through Friday, 8:30 am to 5:00 pm
Registration begins September 19th until October 17, 2004

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You may also mail in your registration by enclosing this form with a copy of the participant's birth certificate and proof of residency along with a check made payable to SOUTH PLAINFIELD RECREATION.

Birth certificates are required for  new registrants
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PLEASE PRINT CLEARLY

Child's Name______________________________________Phone #__________________Date of Birth_________________

Address _____________________________________________________________Height_______________Boy___GIRL___

Age (as of Oct. 1, 2005)_____________________   School Attending______________________________________________

Please circle t- shirt size
        Y.Lg.                             Ad.Sm                       Ad.Med                 Ad.Lg                       AD.XL

Age Group   (circle)            7-8                     9-10                 11-12                  13-14
        

Parents - Please read before signing:
I understand physical risks are involved in my child's/ward's participation in the South Plainfield Youth Basketball Program.  I understand these risks may range from minor bruises to life-threatening injuries.  I have made my child/ward aware of these risks and by allowing him/her to participate in this program, hereby affirm that I fully assume responsibility for these risks.  My signature below confirms my agreement with these statements.

Parent/Guardian Signature:_____________________________________________Date:______________

IF YOU WANT TO COACH: Name________________________________  Phone (h)______________ 
                                            Address _____________________________ Phone (w)______________