Document 6607878

Resident $25
Non-Resident $50
Cash
Check#
Rcpt#/Amount
Birth Certificate
City of Lenoir Parks & Recreation Department
2014 Youth Basketball Registration
Registration Dates: Monday, October 6th thru Friday, November 7th
Player’s Name:__________________________________
Date of Birth:_____/______/_____
School Attending:
Sex: M F
Age on 08/31/14
Playing Experienced: N 1
2
3
More
Shirt Size: YS YM
YL
AS
AM AL AXL
AXXL
Name of Parent/Guardian: (Print)
Mailing Address:______________________________City:________________________Zip_____________
Home Phone:_________________ Work Phone (Mom) _________________ (Work Dad)_______________
Mom Cell Phone:_____________________ Dad Cell _____________________ Fax: ___________________
Email Address:____________________________________________________________________________
(If you want notification on LPR events and sports programs)
Please Indicate Correct Age Division
(Registration eligibility is child’s age before Aug. 31st, 2014. If born on Aug. 31st, child will move up to the next age
division. Example – If child turns 7 on Aug. 31st, then they are playing on 7-8 yr. olds. If child turns 9 on Aug. 31st, then
they are playing on 9 - 10 yr. olds. If child turns 11 on Aug. 31st, then they are playing on 11-12 yr. olds.)
( ) 4 thru 6 Year Old Co-Ed
( ) 11 & 12 Year Old Boys
( ) 7 & 8 Year Old Co-Ed
( ) 9 & 10 Year Old Girls
( ) 9 & 10 Year Old Boys
( ) 11 & 12 Year Old Girls
Parent Involvement
I would like to volunteer as:
[ ] Head Coach
[ ] Assistant Coach
[ ] Concessions
[ ] Scorekeeper
Wavier & Release In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors,
administrators, & assigns, release, & discharge the City of Lenoir, Lenoir Parks & Recreation, promoters, sponsors,
managers, directors, officials, agents, employees & volunteers from any & all claims of injury or liabilities of any
kind, illness, or damages suffered by me as a result of my participation in or traveling to & from sport sessions. I also
give my permission for the free use of my name & picture in any broadcast, telecast, or written account of the event. I
further state that I am in proper physical condition to participate in these sport sessions.
Signature of Parent Or Guardian
Date
Insurance Company
Policy #
Recreation Administrative Offices (828)757-2165 - Fax (828)758-1315
Martin Luther King Center (828)757-2170 Lenoir Aquatic & Fitness Center (828)757-2196
Mulberry Recreation Center (828)757-2165 www.cityoflenoir.com/parks
Parents Code of Ethics
I HEREBY PLEDGE TO PROVIDE POSITIVE SUPPORT, CARE AND ENCOURAGEMENT FOR MY
CHILD PARTICIPATING IN YOUR SPORTS BY FOLLOWING THIS CODE OF ETHICS.
 I will encourage good sportsmanship by demonstrating positive support for all players, coaches and
officials during youth sport events.
 I will place the emotional and physical well being of my child ahead of any personal desire to win.
 I will insist that my child play in a safe and healthy environment.
 I will provide support for coaches and officials working with my child to provide a positive, enjoyable
experience for all.
 I will demand a drug, alcohol and tobacco free sports environment for my child and agree to assist by
refraining from their use at all youth sports events.
 I will remember that the game is for children and not for adults.
 I will do my very best to make youth sports fun for my child.
 I will ask my child to treat other players, coaches, fans, and officials with respect regardless of race, sex,
creed, or ability.
 I will promise to help my child enjoy the youth sports experience within my personal constraints by
assisting with coaching, being a respectful fan, providing transportation, or whatever I am capable of
doing.
 I will require that my child’s coach be trained in the responsibilities of being a youth sports coach and
agree that the coach agrees to the youth sports Coaches Code of Ethics.
 Note: All parents will be held accountable for their actions at all athletic events. If parents do not abide by
this “Parents Code of Ethics”, they will be asked to leave the premises immediately, and further actions
may be taken.
 Note: This “Parents Code of Ethics” must be up held by the entire child’s family members or guardians.
Parents Signature
Players Name
Youth Basketball
Activity/Sport
Date
Recreation Administrative Offices (828)757-2165 - Fax (828)758-1315
Martin Luther King Center (828)757-2170
Lenoir Aquatic & Fitness Center (828)757-2196
Mulberry Recreation Center (828)757-2165 www.cityoflenoir.com/parks
YOUTH BASKETBALL
SKILL ASSESSMENT DATES
Monday, November 17th, 2014
9 & 10 Year Old Boys
5:30 p.m. – 6:45 p.m.
11 & 12 Year Old Boys
7:00 p.m. – 8:15 p.m.
Tuesday, November 18th, 2014
7 Years old (Coed)
5:30 p.m. – 6:30 p.m.
8 Years old (Coed)
6:45 p.m. – 7:45 p.m.
Thursday, November 20th, 2014
9-12 Years Old Girls
5:30 p.m. – 6:45 p.m.
Monday, November 24th, 2014
4 – 6 Year Olds (Coed) 5:30 p.m. – 6:45 p.m.
*Skill assessments will be held in the gymnasium at the Mulberry Recreation Center.
*Have participants ready to play basketball (basketball shoes, shorts, & t-shirt).
Help Fight Childhood Obesity!
Play More, Eat Healthy