My child has permission to play in the MPRB Central Northeast sports program. I hereby release and/or otherwise indemnif
www.minneapolisparks.org
Northeast Minneapolis Parks 2011 Fall Sports Registration
Player Name_________________________________________ Gender: M / F
Birth Date ____/____/______
Address_______________________________________ Apt # _____ City_______________ Zip____________ Preferred Contact #___________________ (Cell/Home/Work) School_________________ Grade________ Emergency Contact Name & Phone #____________________________________________________________
Office Use Only Date ___________________ Paid Fee _______________ Payment Type Cash / Check / Card Check # ________________
Parent Name (s) ______________________________________ Email__________________________________ This registration form must be filled out completely. We will not accept registrations without Birth Date Verification (i.e. Birth Certificate, ID, passport, etc) and Player Fees.
Football—Age Divisions & Locations 9U: Birthdates: 9/1/01 to 9/1/03 Location: Waite • Plus 4th graders during the 2011-12 school year w/ a birth date between 6/1/01—8/31/01
DOB Verified ___________ Staff Initials____________
Player Fees Football: $50 (plus $50 equipment deposit) _____________________________________________________________________________
Soccer and Volleyball: $40
11U: Birthdates: 9/1/99 to 9/1/01 Location: Logan
____________________________________________________________________________
• Plus 6th graders during the 2011-12 school year w/ a birth date between 6/1/99—8/31/99
**Register early and save $5!**
13U: Birthdates: 9/1/97 to 9/1/99 Location: Logan • Plus 8th graders during the 2011-12 school year w/ a birth date between 6/1/97—8/31/97
We accept cash, check, & credit/debit cards. No refunds After the 1st scheduled game
Soccer—Age Divisions & Locations *Please circle preferred location
Please make checks payable to “Minneapolis Finance Dept”
11U: Birthdates: 9/1/00 to 9/1/02 Locations: Bottineau, Luxton, NE, Upper NE, Van Cleve • Plus 5th graders during the 2011-12 school year w/ a birth date between 6/1/00—8/31/00 13U: Birthdates: 9/1/98 to 9/1/00 Locations: Bottineau, Luxton, NE, Upper NE, Van Cleve • Plus 7th graders during the 2011-12 school year w/ a birth date between 6/1/98—8/31/98 15U: Birthdates: 9/1/96 to 9/1/98 Locations: Bottineau, Luxton, NE, Upper NE, Van Cleve • Plus 9th graders during the 2011-12 school year w/ a birth date between 6/1/96—8/31/96
18U: Birthdates: 9/1/93 to 9/1/96 Locations: Bottineau, NE, Upper NE • Plus 12th graders during the 2011-12 school year w/ a birth date between 6/1/93—8/31/93
Volleyball—Age Divisions & Locations *Please circle preferred location 11U: Birthdates: 9/1/00 to 9/1/02 Locations: Bottineau, Logan, Upper NE, Van Cleve • Plus 5th graders during the 2011-12 school year w/ a birth date between 6/1/00—8/31/00 13U: Birthdates: 9/1/98 to 9/1/00 Locations: Bottineau, Logan, Upper NE, Van Cleve • Plus 7th graders during the 2011-12 school year w/ a birth date between 6/1/98—8/31/98
15U: Birthdates: 9/1/96 to 9/1/98 Locations: Bottineau, Logan, Upper NE, Van Cleve • Plus 9th graders during the 2011-12 school year w/ a birth date between 6/1/96—8/31/96 The Minneapolis Park & Recreation Board does not discriminate on the basis of disability in the admission or access to, or treatment or employment in, it’s services, programs or activities. Upon request, accommodation will be provided to allow individuals with disabilities to participate in all Minneapolis Park & Recreation Board services, programs and activities. Upon request, this information can be available in large print, Braille, audio tape and/or computer disk. Does your child receive early education or special education services? If so, any requests for accommodation? Yes/No
Yes/No
Park Locations Audubon Park 1320 29th Ave NE * 612-370-4910 Bottineau Park 2000 2nd St NE * 612-370-4958 Luxton Park 112 St Mary’s Ave SE * 612-370-4927 Logan Park 690 13th Ave NE * 612-370-4927 Northeast Park 1615 Pierce St NE * 612-370-4920 Waite Park 1810 34th Ave NE * 612-370-4959 Windom Park 2251 Hayes St NE * 612-370-4905 Van Cleve Park 901 15th Ave SE * 612-370-4926 Youth sports teams rely on volunteer efforts, how can you contribute if possible? Coach/ Asst. Coach _____ Team Manager ____ Drive/Carpool ___ Become a NE Booster ____ COACHES MUST COMPLETE/ AND PASS A BACKGROUND CHECK AND BE MPRB CERTIFIED
NE Booster Club meetings are held on the 2nd Wed. of the month-7 pm @ Bottineau Park
Waiver and Equipment and Uniform Agreement: My child has permission to play in the MPRB Central Northeast sports program. I hereby release and/or otherwise indemnify the Minneapolis Park and Recreation Board and the NE Boosters against any claim by or on behalf of my child as a result of the child’s participation in the program. I also understand that I am responsible for returning uniforms and equipment at the end of the season. I understand that uniforms and equipment must be brought back clean and in good condition within two weeks of the end of the season.
Coaches or park staff will call registered players with more info about practice times etc. Parent/ Guardian signature: ________________________________________________ Date: _______________
