Remember: Floor Hockey 2008 will be played at the Y-Center's Multi-Sports Complex
NAME ________________________________________________________________
PHONE (primary)____________________________(secondary) ___________________________
ADDRESS ___________________________________________ZIP CODE 490 ____
BIRTHDATE (month/day/year) __________________ CIRCLE: MALE FEMALE
CIRCLE YOUR PRESENT GRADE: PK* K 1 2 3 4 5 6 7 8
PK* means eligible for K in Sept. 2009
SCHOOL THAT YOU ATTEND ______________________________
PARENTS'/GUARDIANS' NAMES _________________________________________________(please print names)
Email address ___________________________________________
PLAYERS' CHECK LIST:
_________ Check here if you've played Floor Hockey in the City
_________ Check here if interested in being a referee. Minimum 8th Grade.
Please check:
_________ Enclosed is my payment of $65.00. You will receive 2 "WPMC Peel-It Cards" that sell for $15 each. Selling the cards will make your signup fee only $35.
OR DO OUR 2ND OPTION TO COVER THE ENTIRE SIGNUP FEE:
_________ Enclosed is my payment of $90.00 You will receive 6 "WPMC Peel-It Cards" that sell for $15 each. By selling the "Peel-It Cards" my child will cover the cost of the signup fee.
PARENTS' CHECK LIST:
_________ COACH (for my child's team)
_________ ASSISTANT (for my child's team)
_________ CONCESSION WORKER (one time only)
_________ MEDICAL PERSONNEL - Although rarely needed, it's nice to know that there's someone in the stands who might be able to help if an injury occurs. If you identify yourself and an emergency occurs, we may contact you. If you are trained for this category, please circle your profession: Doctor, Nurse, Police Officer, Firefighter, E.M.T., or list any other category.
Please print out and mail this form to:
If you have any questions, call Gary Lincoln (979-4336)
All checks/money orders should be made out to "WPMC".