West Union Park and Recreation Department

West Union Park and Recreation Department

P.O. Box 151, 612 Highway 150 South, West Union, Iowa 52175

Office Phone: (563) 422-3685 Fax: (563) 422-3320

2010-11 5th-6th Grade Girls League Basketball

Where: High School

When: Practice will be Saturdaymornings from 9-11 a.m. in November and December.

Practices will be held November 6, 13, 27, December 4, 11, 18

Games will be held Saturday Mornings in January and February

Coaches: Tim Feldman and Antwyan Cullar

Cost: $30 (includes a playing jersey)Registration Due October 29, 2010

This activity is NOT school sponsored. All inquiries should be directed to Park & Rec. Note the contact information above. DO NOT CALL THE SCHOOL asking if there is a cancellation. Park & Rec will notify the school of any change in plans. Changes will be announced to the students at school.

Each child must have a parental permission note to give to the school if they are to go to the Park and Rec activity following school dismissal. Without a parental permission note, the child will follow his/her normal after school procedure. Each child is required to have a parental note as to what the child should do if the activity is cancelled.

Name:______Grade:____ Birth Date:______Girls League Basketball

Address:______Phone Number:______

______Shirt Size ______

(Please indicate Adult/Youth Sizes—Adult Med)

Emergency Contact:______Phone Number:______

Email ______

Please indicate if you would be willing to help coach this activity for your child.

______Yes, I am willing to help coach.

______No, I am not able to help at this time but keep me in mind for future activities.

______No, I am not able to coach.

Waiver form: Program registrants assume full responsibility for any risk, implicit or direct, by participation in said activity or facility.

I, parent/guardian of the entrant listed above, waive and release any and all rights and claims for damages against the program listed above, its coaches, the City of West Union and its Parks and Rec. Department/Board and its employees, other sponsors, coaches and volunteers, for any and all injuries that may be suffered by the entrant listed above in connection with the above registered activity.

Parent/Guardian Name:______

Signature:______

Upcoming Events: Baseball/Softball begins in April. Look to sign up in March.

Open Gym on Saturdays from November-February 1-4 pm