Family Plants and Pillars Homeschool Sports Registration 2013-2014

Please return to Plants and Pillars, c/o The Hartmans, 2105 Clayton Road, Beaver Falls PA 15010 Registrations due July 31, 2013. Early registration is necessary for planning purposes. Family Info: Last Name _____________________________________________________________ Parent Names ___________________________________________________________ Primary Telephone Number ________________________________________________ Home Address __________________________________________________________ E-mail _________________________________________________________________
Child Name ________________________________ Grade _______ Birthdate ____________________ Please circle each sport child plans to participate in: 6-8 grade Soccer 9-12 grade Soccer 4-6 grade Basketball 9-12 grade Basketball 6-8 grade Basketball 1-5 grade Soccer

6-12 grade Track and Field

Child Name ________________________________ Grade _______ Birthdate ____________________ Please circle each sport child plans to participate in: 6-8 grade Soccer 9-12 grade Soccer 4-6 grade Basketball 9-12 grade Basketball 6-8 grade Basketball 1-5 grade Soccer

6-12 grade Track and Field

Child Name ________________________________ Grade _______ Birthdate ____________________ Please circle each sport child plans to participate in: 6-8 grade Soccer 9-12 grade Soccer 4-6 grade Basketball 9-12 grade Basketball 6-8 grade Basketball 1-5 grade Soccer

6-12 grade Track and Field

Child Name ________________________________ Grade _______ Birthdate ____________________ Please circle each sport child plans to participate in: 6-8 grade Soccer 9-12 grade Soccer 4-6 grade Basketball 9-12 grade Basketball 6-8 grade Basketball 1-5 grade Soccer

6-12 grade Track and Field

If more children participating please use the back of this paper.

Fees Check all that apply. 2013-14 Fees ____$10 family registration fee is due with registration. This goes toward administrative costs of the program, and will no longer be credited toward individual sport fees. This is the only fee due with registration all other will be assessed at the beginning of each season. Please do not send cash, make checks out to Plants and Pillars. ____ We plan to participated in the work-a-thon and send support letters. Please send us a fundraising packet. (To view information about the work-a-thon please see the website, www.plantsandpillarsathletics.org). ____ We plan to participate in the work-a-thon, but will not be sending support letters. 1st 5th Grade Soccer ____ $10 per student High School Basketball/Soccer ____$125 ____$100, participate in work-a-thon, but not send support letters ____$50, participate in work-a-thon, and send support letters Junior High Basketball/Soccer ____$100 ____$75 participate in work-a-thon, but not send support letters ____$50, participate in work-a-thon, and send support letters 4-6 Grade Basketball ____$75 ____$65 participate in work-a-thon, but not send support letters ____$50 participate in work-a-thon, and send support letters 6-12 Grade Track and Field ____$75 ____$65 participate in work-a-thon, but not send support letters ____$50 participate in work-a-thon, and send support letters We would be willing to help in the following way: ____Coordinate the work projects for the work-a-thon. ____Coordinate carpooling, for those who desire to take part, for one team. ____Keep stats (or coordinate the keeping of) for a high school team. ____Coordinate scorebook keepers/scoreboard operators for one JH/HS basketball team. ____Coordinate a separate fundraiser for high school uniforms for one team (without this we will continue with the same uniforms we have had for the junior high teams). ____Plan and carry out end of season party for fall or spring season. ____Commit to being an assistant for one of the teams (with more teams we need more coaches even if you cant commit to being a head coach if you could commit ahead of time to be at certain practices that would be a tremendous help to coaches you would be given drills, etc to carry out with groups of kids). ____Track meet volunteers

Please return this sheet with your registration papers. Please fill out one of these for each child participating. (We realize some of this is repeat information, but each page goes to different records, so thanks for completing again!) Childs Info: Last Name ________________________ First Name ___________________________ Sex ____ Age ____ Birthdate ________________________ Grade _____ Street Address ___________________________________________________________ City ___________________________________ Zip____________________________ Parent Info: Last Name _________________________ First Names __________________________ Primary Phone Number ____________________________________________________ Cell Phone Number _______________________________________________________ Email __________________________________________________________________ I understand, by the nature of the activity, that there is a possibility of accident, and I assume the risk and responsibility while my child participates on this team. I hold harmless Plants and Pillars and / or its representatives, as well as the host facility / school and its representatives, for any injury that my child may sustain during participation in this athletic season. I also forfeit legal action or compensation claims against Plants and Pillars and / or its representatives, or against the host facility / school and / or its representatives, for injuries my child may sustain. I, as parent / guardian of a minor student, consent to emergency care to be administered to the minor as deemed necessary by the involved physician and / or hospital which is to administer the required treatment of the emergency condition. I also understand that all incurred costs are my personal responsibility, and that Plants and Pillars and the host facility / school and coaches do not have medical insurance coverage for injuries to the minor as a student participant. Parent/Guardian Signature: ______________________________ Date: ____________ Health Insurance Carrier: ___________________________ ID Number: _____________ Group Number: _________________ Physician / phone number: ___________________ Medications: _____________________________________________________________ Allergies: _______________________________________________________________

Other Important Medical Information: _______________________________________________________________________ _ _______________________________________________________________________ _