NAME ________________________________________________________________

PRIMARY PHONE ________________________________SECONDARY PHONE _______________________

ADDRESS ___________________________________________ZIP CODE 490 ____

GRADE _______ CIRCLE: MALE FEMALE

HEIGHT: ___ FT. ___ IN. (Please Measure) BIRTH DATE _____ _____ _____

SCHOOL THAT YOU ATTEND ______________________________

PARENTS'/GUARDIANS' NAMES ________________________________________________(print )

Email address ___________________________________________

PARENTS: WE ARE IN NEED OF COACHES, ASSISTANTS, CONCESSION WORKERS AND PEOPLE IN THE MEDICAL/EMERGENCY CARE FIELDS. PLEASE VOLUNTEER YOUR TIME BY CHECKING IF YOU ARE ABLE TO SERVE AS:

______ BASKETBALL COACH (My child's team)

______ ASSISTANT COACH

______ CONCESSION WORKER (One time only)

______ EMERGENCY MEDICAL PERSONNEL - This worked successfully last season. Although rarely needed, it's nice to know that there's someone in the stands that might be able to help if an injury occurs. If you identify yourself we'll know that you might be there during the duration of your child's game. If an emergency occurs, we'll be able to contact you. If you are trained for this category, please indicate your profession (for example: doctor, nurse, fire fighter, police, etc.) Thanks for volunteering.

PLEASE CHECK:

______ Enclosed is my check or money order for $50.  You will receive 1 "WPMC Peel-It Card" that sells for $15.  Selling the card will make your signup fee $35 (same as last year).

______ Enclosed is my check or money order for $45.  I WILL NOT receive a "WPMC Peel-It Card."

OR "ANOTHER" OPTION TO COVER THE ENTIRE SIGNUP FEE:

______ Enclosed is my check or money order for $90.  You will receive 6 "WPMC Peel-It Cards" that sell for $15 each.  By selling the "Peel-It Cards" my child will cover the entire cost.

Mail your form and check or money order (made out to "Wattles Park Men's Club") to:

Additional Signup Forms are available on the Internet at www.wpmc.net

Return to WPMC Basketball page.