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 come to the orientation meeting Sunday, October 27 at 5:30 p.m., basement of First United Methodist Church, 313 East Montgomery.
Bring the family to an orientation meeting Sunday, October 27 at 5:30 p.m., basement of First United Methodist Church, 313 East Montgomery. SEE YOU THERE!
