NORTH HANOVER TOWNSHIP RECREATION

							  1000                  NORTH HANOVER TOWNSHIP RECREATION
                          LIABILITY RELEASE & PERMISSION SLIP

                                                 Basketball
Parent Information:                     Home Phone              Cell Phone                  Work Phone
Mother ___________________ ____________                         ____________                ____________
                Mother’s Email: _______________________________________________
Father ___________________ ____________                         ____________                ____________
                Father’s Email: ________________________________________________
Guardian ________________               ____________            ____________                ____________
                Guardian’s Email: ______________________________________________
Address _________________________________________________
         _________________________________________________                                  _____ _______
                      Note: Please include area codes with all phone numbers


Player’s Information:
                                          Grade
                                         Current
Player’s name         Birth date        School Year             Sex     Age      Charge             Uniform Deposit




                              Registration fee: $_________________               Uniform Fee: $_________________

                                                                                 Total Due:          $_____________
Players name                       Shirt size                   Pants size                          Shoe size




                               Please see page two for eligibility to play in each sport.

                                                                                 Please include area codes with all phone numbers.


Emergency Information:                            Home phone            Cell phone                  Work phone

Emergency name _________________________         ____________           ____________                ____________

Doctor’s name: __________________________________________ Doctor’s phone: ________________________
Parent participation:                              Coach     Asst. Coach    Fields     Rec. Comm.     Need Certification

                                  Mother
Please Check the areas where
you are willing to help           Father

                               Guardian


Eligible to participate:                                                    Participation fees per player:

Baseball:        (Age – April 30)          4 years ---- 14 years            There is a one time uniform fee in
                                                                            the amount of $35.00
Basketball:      ( Grade )                   K5 ---- 12th grade
                                                                            K4 thru 12th grade ---- $30.00
    Soccer:      ( Grade )                   K4 ---- 12th grade                      There is a $25.00 late
                                                                                       registration fee.

                              Registration fee is a non-refundable fee.
     Uniform deposit can be requested back when players move out of Township or are too old to
                                 participate in the recreation sports
                              (up to 2 month’s after leaving 12th grade)

I/we, the undersigned parent/guardian of the child/children named above do hereby grant permission for him/her to
participate in the sports program. I/we also assume all risks and hazards incidental to such activities and participation by
my/our child/children, including transportation to and from the activity and all risks and hazards incidental to my/our
child/children or caused by my/our child/children playing sports while wearing glasses. I/we hereby release and agree to
hold harmless the Township of North Hanover, the North Hanover Township Recreation Advisory Committee, the
Midlands Soccer League, the NBIAA and their appointed referees, organizers, sponsors and supervisors of the aforesaid
activities and any and all other participants from any and all claims and/or liability arising out of any injury to or caused by
my/our child/children. I/we also grant permission for any emergency medical procedure(s) deemed necessary by the
person in charge of the activity at the time of the incident/accident or by a licensed physician who may be present at the
time of the incident/accident. I/we understand the coach or director of the above activities is responsible for the conduct
of my/our child/children and any/all decisions regarding the above activties without challenge. I/we also agree to abide by
the rules and regulations regarding conduct, policies and procedures. I/we understand that parent/guardian participation
is crucial to the success of the recreational programs and is expected. Disregard for the above may result in eliminiation
from any current or future programs conducted by the North Hanover Township Recreation Advisory Committee.



Signature of Parent/Guardian __________________________________ Date __________________




Remember to enclose check payable to “North Hanover Township”

                                      Return registration and check to:
                                     North Hanover Township Recreation
                                            41 Schoolhouse Road
                                           Jacobstown, NJ 08562

                          Deadline for sign up is October 31