BES INTRAMURAL SPORTS REGISTRATION FORM

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TO: Parents of Students in Grades 5 & 6

FROM: Kyrstin Bervert

DATE: January 17, 2022

Intramural sports are offered each year for 5th & 6th grade students to participate in, the fee is $25.00 per year. Our next session is basketball. If your child is interested in the basketball session, you will need to fill out the registration form below and submit it with $25.00 (if not already paid during a previous session) to school by Monday, January 31st. (Without this registration form being submitted completely and payment made, your child will not be able to participate). The session will run from Monday, January 31st through Tuesday, March 1st. Practice will be held AFTER school every Monday, Tuesday, and Thursday from 4:15pm to 5:15pm for both boys and girls. Participants should be picked up promptly at 5:15pm. Please use the drive thru lane for pick up and have your pick-up name signs in your windshield.

**PARENTS: The Buffalo Classic Basketball Tournament will be held on March 3rd from 5:00-8:00pm. Students will not be allowed to stay after school between dismissal and the start of the tournament. Please mark your calendars!

Each student is responsible for his/her own transportation. Supervision for your non-participating students is not available.

The school district provides insurance for students while they are participating in school sponsored activities. It is a co-insurance with your family policy and the coverage is limited. Please read the certificate of coverage handed out at enrollment.

INTRAMURALS is designed to be a fun program for all levels of physical abilities. This session will offer basketball activities. This program requires students to exhibit appropriate behavior during the limited one-hour activity. This will allow our coaches and students to cover more of the basic fundamentals of the sport. Students who are unwilling to follow coaches' instructions will not be allowed to continue the program.

Does your student have permission to participate in the Intramurals session of basketball? *

YES

Child's First Name *

Child's Last Name *

Child's Gender *

Male

Female

Child's Grade *

5th

6th

Parent First Name *

Parent Last Name *

Parent Contact Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

I understand that the program will start on Monday, January 31st and run through Tuesday, March 1st. Practice will be held every Monday, Tuesday, and Thursday AFTER school, from 4:15pm-5:15pm, for boys and girls. *

YES

I understand that The Buffalo Classic Basketball Tournament will be held on March 3rd from 5:00-8:00pm, and that students will not be allowed to stay after school between dismissal and the start of the tournament. *

Option 1

I understand that the school does not provide transportation for my child, and in order for him/her to participate it will be my responsibility to provide transportation. *

Yes

I understand that Intramurals participants should be picked up promptly at 5:15pm, using the drive-thru lane, and will have our pick up name sign in our windshield. *

YES

I understand that if I am going to be late , the Berryton Office is CLOSED at pick up time of 5:15, and I would need to EMAIL one of the Intramurals coaches if needed. (Coaches are Mrs. Hotujac hotujaco@usd450.net and Mrs. Berry berryc@usd450.net ) *

YES

I understand that if my child is consistently being picked up late from Intramurals, my child may be removed from the program. *

YES

I understand the school does not provide supervision of non-participants. *

YES

I understand that the ONE TIME yearly fee of $25 for Intramurals will need to be sent to the school office, or paid over the phone via credit/debit card, prior to my child starting the program. *

YES

Parent Signature: Typing your name below stands for your signature and permission for your child to participate in the Intramurals session of basketball. *

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