Open to Adults & Seniors - Mequon-Thiensville School District

Youth Sports Continued 37
SLAMMERS BASKETBALL
FOR BOYS & GIRLS IN GRADES 4-5
A winter recreation basketball league for boys and girls in 4th & 5th Grade. There will be separate boys and girls
divisions. 10-foot baskets will be used. The first date, December 9th, will be an evaluation day and attendance
is required.
Times for December 9th are as follows: 4th & 5th grade girls 12:00 - 1:30pm Main Gym
4th & 5th grade boys 1:30 - 3:00pm Field House
December 16th will be a practice day ONLY. Game dates are January 6, 13, 20, 27, February 3, 10, 17, & 24. A
schedule of game times will be created, and you will be notified by your coach. Each game date will include a
30-minute practice followed by a game.
Additional practice times will be available during the season and times will be notified to the coaches. Games in
the 4-5 grade division will be officiated by an adult.
Prerequisite: Boys & Girls
Ages: Grades 4-5
Location: Homestead High School
Fee: $57
Dates: Sundays, December 9, 16, January 6, 13, 20, 27, February 3, 10, 17, & 24
Course #: Girls Grade 4 & 5 #117038 Boys Grade 4 & 5 #117042
Times: Noon or 1:30pm 1:30pm, or 3:00pm
(Start time is not a choice) (Start time is not a choice)
Registration: Registration is limited based upon space available. It is highly recommended to register
as soon as possible to assure a spot. Registration for Slammers needs to be completed on the Slammers
Basketball Registration Form. DEADLINE IS NOVEMBER 9, 2012.
Teams will be coached by parent volunteers: For those interested in coaching, please state your interest on the
registration form. All coaches will need to attend one of the two scheduled coaches meetings: Monday, November
26th or Wednesday, December 5th, 7:00pm, in the Homestead High School Lecture Hall. All coaches will have to
be present for the evaluation on Sunday, December 9th.
SLAMMERS BASKETBALL REGISTRATION FORM – FALL/WINTER 2012-13
First/Last Name (person completing the form)
Parent Email Address
Address City Zip
Home Phone Work/Day Phone Cell Phone
Please note any special needs or comments:
Player Name Birth Date
Grade in Fall of 2012 ______ ____ Male ____ Female Height _________ Weight ________ (Ht. & Wt. necessary)
Course # Fee
All participants are requested to sign the following release. Parent or Guardians must sign for minors.
I/We the undersigned, do hereby agree to allow the above named to participate in the activity indicated. I am/We are
aware of and understand that there may be potential risks inherent with participating in any recreational activities and
that the Mequon-Thiensville School District and the M-T Recreation Department does not provide accident insurance.
I/We assume all risks and hazards incidental to such participation including transportation to and from the activities
and do hereby waive, release, absolve, indemnify and agree to hold harmless the M-T Recreation Department
employees, staff, and other persons for any and all claims, injuries, liabilities, damage or right of action directly or
indirectly arising out of use of M-T Recreation Department activities. In the event of a medical emergency, I
authorize the department staff to obtain medical treatment for the above named. I and my child hereby
acknowledge having received education found on the Rec Dept website or in the Rec
Dept office about the signs, symptoms, and risks of sport related concussions. I and my
child acknowledge our responsibility to report to our coaches, parent(s)/guardian(s)
any signs or symptoms of a concussion.
SIGNATURE: DATE:
Coaching Information: ___ Yes, I would like to be a Head Coach ___ Yes, I would like to be an Asst. Coach
Name (W) Phone
Email
Who, if anyone, do you want to coach with (can’t guarantee more than two coaches per team)?
Date Processed
_______/_______/_______
Payable to
M-T Recreation Department
11040 N. Range Line Rd
Mequon, WI 53092
____ Check
____ Cash
Credit Card
____ MasterCard ____ Visa
Card #
Expiration Date
_________/_________
Card Verification # __________
(See back of card)
Card Holder Name
Signature