BASKETBALL ACADEMY REGISTRATION

First Church – 

United Methodist 

Basketball Academy

YOUTH BASKETBALL

SKILLS AND DEVELOPMENT PROGRAM

November 4 – January 15

Grades 5 & 6 – Any skill level encouraged to participate

Boys session Monday & Wednesdays

Girls session Tuesdays & Thursdays

3:30 – 5:00 p.m. at Memorial Hall

Christian environment with fun & fellowship

Teaching basketball skills and good character!

Transportation from school is available—indicate necessity on

Registration form

Director:  Joel Johnson, KHS Varsity Baseball & former Varsity Girls Basketball Coach

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BASKETBALL

ACADEMY

5^th/6^th Grade – 2013 

REGISTRATION FORM               

Need Transportation?   Yes / No

Participant Information:

Name:  ______________________________________

Grade_____  

Gender:  Boy / Girl

Address:  ____________________________ 

City: ___________________ 

Zip: ____________

Phone: __________________ 

Email: ________________________________(print clearly)

T-shirt Size:  ______________ 

                      Adult: S-XXL  Youth: S-XL

Last Name for Shirt Back _______________________________

                

Emergency Contact Information:

Name:  ___________________________________________ Relationship:_______________________

Phone:  ________________ Please indicate any allergies(snacks will be provided) or medical problems staff should be aware of:  __________________________________________________

Release of Liability and Assumption of Risk

The use of the premises, facilities, equipment, and services at Knoxville First United Methodist Church naturally involves risk of injury to you or your guest, whether you or someone else cause it.  As such, you understand and voluntarily accept this risk and agree that Knoxville First United Methodist Church will not be liable for any injury, including, without limitation, personal, bodily, or mental injury, economic loss or any damage to you, your spouse, guests, unborn child, or relatives resulting from the negligence of Knoxville First United Methodist Church or anyone on Knoxville First United Methodist Church’s behalf or anyone using the facilities. 

Picture Release

I hereby give my consent to let my child be photographed for use by the Knoxville First United Methodist Church to be used in newspaper or other media.  No names except First United Methodist Church will be used.

______________                 ______________________________

Date                                                                        Signature of Parent or Guardian

COST:  $25.00           

Mail or deliver to church office or bring to orientation meeting on Sunday, October 27 at 5:30 p.m., basement of First United Methodist Church.  Checks payable to First United Methodist Church.

Scholarships available upon request based on economic need and hardship.  Please contact Joel Johnson at johnsonhome@iowatelecom.net, or call 641-891-9739, or stop by church office. 

Please come to the orientation meeting Sunday, October 27 at 5:30 p.m., basement of First United Methodist Church, 313 East Montgomery.