NAME ________________________________________________________________

PRIMARY PHONE ______________________SECONDARY PHONE _________________

ADDRESS ___________________________________________ZIP CODE 490 ____

GRADE _______ CIRCLE: MALE FEMALE

HEIGHT: ___ FT. ___ IN. (Please Measure)          BIRTH DATE _____ _____ _____

SCHOOL THAT YOU ATTEND ______________________________

PARENTS'/GUARDIANS' NAMES _______________________________________________(print )

Email address ___________________________________________

PARENTS: WE ARE IN NEED OF COACHES, ASSISTANTS, CONCESSION WORKERS AND PEOPLE IN THE MEDICAL/EMERGENCY CARE FIELDS. PLEASE VOLUNTEER YOUR TIME BY CHECKING IF YOU ARE ABLE TO SERVE AS:

______ BASKETBALL COACH (My child's team)

______ ASSISTANT COACH

______ CONCESSION WORKER (One time only)

______ EMERGENCY MEDICAL PERSONNEL - This worked successfully last season. Although rarely needed, it's nice to know that there's someone in the stands that might be able to help if an injury occurs. If you identify yourself we'll know that you might be there during the duration of your child's game. If an emergency occurs, we'll be able to contact you. If you are trained for this category, please indicate your profession (for example: doctor, nurse, fire fighter, police, etc.) Thanks for volunteering.

PLEASE CHECK:

______ Enclosed is my check or money order for $55. 

Mail your form and check or money order (made out to "Wattles Park Men's Club") to:

QUESTIONS?????    email wpmc49@aol.com or call Gary Lincoln at 979-4336

Additional Signup Forms are available on the Internet at www.wpmc.net

Return to WPMC Basketball page.