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
5th/6th
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 attend an orientation
meeting Sunday, October 27 at 5:30 p.m., basement of First United Methodist Church,
313 East Montgomery.
