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RVCBL - Hoops for All Participant Registration
Rockville Centre Special Needs Basketball Clinic
Location: RVC Rec Center (111 N. Oceanside Rd)
Grades 3-8 - 9:00am-10:00am
Grades 9-12 - 10:00am-11:00am
ONE FORM PER PARTICIPANT
(Volunteers should use Volunteer Registration Form)
SECTION 1 - PARENT/GUARDIAN INFORMATION
Name
First
Last
Cell Phone
###
-
###
-
####
Email
Participant Information - Separate form for each participant
Name
First
Last
School
Shirt Size
Please select
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Grade (number only)
Would like to participate on:
Sunday, January 7
Sunday, January 21
Sunday, January 28
Sunday, February 11
Sunday, February 25
Please indicate what, if any, assistance your child may need or any special conditions we should know.
Signature:
By signing and submitting this permission slip, you agree that your child is in good medical condition to participate in this clinic.
*
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