Registration

Participant Name*

First Last

Age*

Birthdate*

MM

DD

YYYY

Gender*

Male
Female

In what middle school district do you live?*

Valley Point (Valley Point and Dug Gap)
Eastbrook (Antioch, Eastside and Cedar Ridge)
Westside (Tunnel Hill and Westside)
New Hope (New Hope and Pleasant Grove)
North Whitfield (Beaverdale, Varnell, Dawnville and Cohutta)
Christian Heritage
Other (Walker, Catoosa, Murray, Dalton City)

School*

If not in school yet please list school participant will attend.

Sport Playing*

Division is based off what age your child is on or before September 1st 2020. Must have turned 5 before November 1st 2020.

Shirt Size*

Short Size*

Jersey Number*

Please enter a number from 0 to 99.

0-5, 10-15, 20-25, 30-35, 40-45, 50-55

Guardian Name*

First Last

Guardian Phone #1*

Guardian Email*

Interested in Coaching?*

Yes
No

IF YES: Head Coach or Assistant Coach?

Head Coach
Assistant Coach

Notes (No Coaches Requests)

Consent*

The information in this form is correct and I give my Consent for this participant to play.

- Playing up must be approved by WCRD

Payment*

I agree to payments of Cash, Check, Credit Card or Past Credit when due.

Payment Options
-Cash
-Check
-Credit Card
-Credit from Spring 2020 (Covid-19 Cancellation)

All Payments are due by November 13th.

You can also call WCRD Office at 706-226-8341 or drop off payments at Edwards Park.

Untitled

Paid Cash/Check
Paid PayPal
Paid $10-Had $20 Credit
Paid $20-Had $10 Credit
Credit from Spring 2020
Owes $10
Owes $20
Owes $30

2020-21 Winter Registration (Basketball)

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