Wattles Park Men's Club - Floor Hockey Signup

Remember:  Floor Hockey 2017 is played at the Y-Center's Multi-Sports Complex

NAME ________________________________________________________________

PHONE (primary) (269) ___________________________ (secondary) (269) ___________________________

ADDRESS ___________________________________________ZIP CODE 490 ____

BIRTHDATE (month/day/year)  __________________    CIRCLE: MALE   FEMALE

CIRCLE YOUR PRESENT GRADE:   PK*   K    1    2    3     4    5    6    7    8  

PK* means eligible for K in Sept. 2018

SCHOOL THAT YOU ATTEND ______________________________

PARENTS'/GUARDIANS' NAMES _________________________________________________(please print names)

Email address ___________________________________________

PLAYERS' CHECK LIST:

_________ Check here if you've played Travel Floor Hockey during the last 2 years

_________  Check here if interested in being a referee.  Minimum 7th Grade.

Please check:

_________ Enclosed is my payment of $55.00

PARENTS' CHECK LIST:

_________ COACH (for my child's team)

_________ ASSISTANT (for my child's team)

_________ CONCESSION WORKER (one time only)

_________ MEDICAL PERSONNEL - Although rarely needed, it's nice to know that there's someone in the stands who might be able to help if an injury occurs. If you identify yourself and an emergency occurs, we may contact you. If you are trained for this category, please circle your profession: Doctor, Nurse, Police Officer, Firefighter, E.M.T., or list any other category.

Please print out and mail this form to:

WPMC c/o Gary Lincoln
13166 Eleven Mile Road
Ceresco, Michigan 49033

If you have any questions, email Gary Lincoln at wpmc49@aol.com or call 979-4336.

All checks/money orders should be made out to "WPMC".

Return to WPMC Floor Hockey Page.