IN-TOWN
Field Hockey Program
This program is sponsored by South Brunswick Township Parks and Recreation in cooperation with the South Brunswick Family YMCA Residents Girls Only 3rd-12th grades This is an instructional Program For: July 6th, 2009 Location: TBA: Township School Gymnasium Registration Registration is limited and dependent upon the number of Volunteers who sign up to coach teams. 0pens: Registration Deadline: Fee:
Sign up early to assure a space on a team. October 16th, 2009 Registration received after 10/16/09 will be placed on a waitlist. If space is available you will be called. $60.00 fee for each child. Each child must bring their own mouth guard and stick. Checks are to be made out to: South Brunswick Twp. Financial aid is available for qualifying residents. Call ext. 7671 for application. A minimum # of participants is required in order to run the program.
To: Register Recreation Office, 8:30 am- 4:15 pm M – F Located at 124 New Road at Woodlot Park. BY MAIL, SEND TO: So. Bruns. Parks & Recreation Dept. P.O. Box 190, Monmouth Jct. JN. 08852 IN PERSON: The Website: INFORMATION: www.sbtnj.net You may download additional registration forms. (Click on Recreation) 732-329-4000 X 7671 or 7680 TDD: 732-329-2071
Each participant must provide their own mouth guard and stick. Program will run for 1 hour during the week in the evening and for 1 hour on Saturdays. Times will be announced closer to the start of the program. Program will begin January 6th, 2010 Program will end March 3, 2010 The program will take place at a local elementary school gym. Inclement weather number: 732-329-4000 x 7686, 8:00 am
South Brunswick Parks & Recreation Dept.
2010 Field Hockey Registration Form
Please fill out form completely and legibly
Grade The Child is In: Winter 2010: (Check one): ___ 3-5 ___ 6-8 Previous experience: (Check one) ___ 1 year ___ 2 years ___ 9-12 ____ Playing on a school Team
TEE SHIRT: please circle: Youth sizes: Med (10-12) Lg(14-16) Adult Sizes: Sm Med Lg. XL
Child’s Last Name:__________________________________ Child’s First Name:___________________________________ Child’s Grade:_________(Current year) Parent’s Name (Mother):__________________________________( Father) __________________________________________ Parent’s Cell Phone Number:_________________________ Parent’s Email:_______________________________________ Address Street ________________________________ Town_______________________ Zip Code_____________ Home Phone Number:______________________________ Emergency Contact Name and Number_______________________________________________________________
Volunteers are Important for the success of our program. We encourage all parents to Volunteer. If you are interested in volunteering please fill out the following information. PLEASE CIRCLE ONE: Assistant or Head Coach
I want to Coach with_____________________________________________ First Name________________________________ Last Name____________________________________ Phone Number_________________________ Contact E-mail______________________________________ T-Shirt Size_____________________
BE ADVISED: Users of South Brunswick recreational facilities and participants in recreational activities sponsored by the Township should recognize that conditions in and about the recreational facilities and the nature of certain activities all present certain reasonable and foreseeable risk of injury. Users and participants assume all reasonable risks, which may exist by virtue of the conditions existing at the facilities, or volunteers liable in the event of accident or injury while participating in its activities and/or while using Township and /or recreational facilities. If none of the listed parents, guardians or emergency contacts can be reached by phone, I do hereby give my permission to the attending physician to hospitalize and /or administer proper medical treatment, order anesthesia and /or surgery for my child in a medical emergency.
Parent/guardian, please read and sign:
My child has my permission to participate in Field Hockey. I register my child with the understanding that special requests for team placement, coaches, practice/game days or location will not be accommodated.
Signature, Parent/Guardian _________________________________ Date: ______________________ For office use only: Receipt #: Amount: Date: ____Cash Check #:
Initials: