SPRINGFIELD PARKS & RECREATION DEPT. WINTER PLAYER REGISTRATION FORM Sport: Wrestling K Basketball 1/2 Basketball 3/4 Basketball (CIRCLE ONE) 5/6 Basketball SPRINGFIELD PARKS & RECREATION 2021-22 WINTER SPORTS BROCHURE Other 139 Main St. Springfield, VT 05156 Phone: (802) 885-2727 E-mail: springfieldrec@hotmail.com Facebook: Springfield, VT Parks & Recreation Website: www.springfieldvtparksandrec.com Director: Andy Bladyka, Assistant Director: Keith Eno Maintenance Supervisor: John Robison (PLEASE PRINT CLEARLY BELOW!) CHILD’S NAME________________________________________________________ ADDRESS______________________________________________________________ TOWN & STATE__________________________/________ ZIP CODE _________ DATE OF BIRTH_________ /________ / _________ AGE GRADE GENDER: M / F (CIRCLE ONE) PARENT’S E-MAIL__________________________________________________________________________ ALTERNATE E-MAIL________________________________________________________________________ HOME PHONE OR CELL PHONE #_______________________________ Registration Dates will be: Online registration: October 29th- December 5th. In-person registration: November 1st-24th: 7:30 am-8:00 pm at the Community Center Office, Monday-Friday. It will be staffed from 7:30 am-5:00 pm. We have online registration on our new website! (Cheaper to sign up online.) Link listed above! CELL PHONE # _______________________________________ Will you volunteer to help this program? Coach Assist (CIRCLE IF ONE APPLIES) Does the child have any handicaps/physical disabilities? YES NO (CIRCLE ONE) If yes, please explain: __________________________________________ (Gr. 3-6) Short Size: YS (6/8) YS YM YM (10/12) YL YL (14/16) AS (CIRCLE ONE) AM AL AXL AS As fall fades towards winter, Parks & Rec. would like to take a moment and thank some individuals, and groups whose help and support allowed our fall programs to excel. AM AL AXL SPRINGFIELD PARKS & RECREATION DEPT. AGREEMENT In consideration of the acceptance of this application by the Parks and Recreation Dept. of Springfield, VT we, or I, the legal parent or guardian of___________________________________________, for ourselves, our heirs, executors, administrators and assigns, hereby agree to waive any and all claims which may accrue by virtue of the entry or participation in such activities, against the Town of Springfield, Vermont, the Parks and Recreation Dept. of Springfield, Vermont their duly elected representatives, its Superintendent or any member or members of the other participating teams, their agents or representatives. PARENT/ GUARDIAN SIGNATURE______________________________________ DATE______________ (WE ARE ON FACEBOOK! CHECK US OUT FOR DAILY UPDATES!) ============================================================================================== (OFFICE USE ONLY) PAID: YES/ NO (FEE$ TEAM ) apparel store on our website! Fall Appreciation Medications: _________________________________________________ T-Shirt/Jersey Size: Apparel reminder: We have partnered up with Clever Cow Designs and now have an online Springfield Spirit: Coach Ray Curren and the varsity girls’ soccer team did a fantastic job running teams along with a hand full of parents with our K-2 soccer program. Thank you for all of your great work!!! Volunteer Coaches: As always we need to say a huge THANK YOU to all of our Fall Program volunteer coaches. 5/6 girls’ soccer coaches: Craig Streeter, John Conway, Bevin Packman, & Will Simoneau. 5/6 boys’ soccer coaches: Jess Burlew & Pete Peck. 3/4 girls’ soccer coach TJ Whipple & Samantha Snyder. 3/4 boys’ soccer coaches: Margie Reurink & Elijah Daniels. Youth Tackle Football coaches: Alden Tewksbury, Paul Little, Nick Barlow, Tim Merrow, Chris Cenate, Jason Farnsworth, Zach Colburn, & Chris Merrill. K-2 Flag Football: Dave Wright, Chris Blanchard, Jay Clapperton, Jake Wilson, Ryan Keefe, & Travis White. Community Support: Families need to know that NO CHILD should miss out on participating in a Parks & Rec program for financial reasons. We are fortunate to have resources available. The Kurt Dechen fund provides uniform fees and program fees for all sport seasons for children at our discretion, and we have another uniform fund provided by donations in honor of deceased Springfield Athletic supporters, Bo Birsky, Vic Yesman, Bud Ingalls, and Fran Greene and their families. Assistance will be confidential and there is no paperwork required; just a conversatio

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