Village of Lewiston Recreation - Red Brick Youth Basketball Registration Form - Fall/Winter 2021-22                                                        
Village of Lewiston Recreation Address: 145 N. 4th Street, Lewiston, NY 14092
Contact us at (716) 754-1990 or recreation@villageoflewiston.com

RELEASE OF LIABILITY:

In consideration of permitting the below-named child to participate in games, practices, and other activities of the Village of Lewiston Recreation Department, I, the undersigned as parent or guardian of said minor, do hereby release and agree to hold harmless the Village of Lewiston Recreation Department and its said agents, employees, coaches and volunteers from any liability for bodily injury, personal injury or property damage which may occur to said minor on the part of said program or its agents, employees, coaches and volunteers related to this program.

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Email *
Child's Last Name *
Child's First Name *
Date of Birth *
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Street Address *
Town *
Zip *
Parent's Full Name *
Parent's Emergency Contact Number *
Division *
I understand that I will have to pay $50 per child and that players will recieve a reversible jersey. Payment can be cash or checks made out to Village of Lewiston Recreation Department. Payment can be brought to the first session or mailed prior to Village of Lewiston Recreation, P.O. Box 325, Lewiston, NY 14092. *
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A copy of your responses will be emailed to the address you provided.
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