Basketball and Volleyball Spring (Open Gym): Weekly Registration                     
21st CPA Athletic Department will be hosting a Basketball and Volleyball Spring Recreational Event in the Gymnasium for the Spring Semester. All students that attend will have the opportunity to engage in recreational play within a supervised school environment. 

Basketball and Volleyball Spring Recreational Event (Co-Ed)

Price:                            $3 each Open Gym Event (Registration fee due prior to event start)
                                           **Cash Only**

Dates/Times:               
  • Volleyball:        Monday, May 15 @ 4-5:30p
  • Basketball:      Thursday, May 18 @ 4-5:30p
Grade Level:                5th-8th Grade: Boys and Girls
                                               **LIMITED SPACES**
               **Snack bar may be available for athletes at some events. **

Deadline to Register athlete for Open Gym:    
                       -Child must be register prior to participating in any events.
     
For more information or details of events please contact: Dana "DA" Alexander at dalexander@21stcenturypa.com
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Email *
Athletic Apparel + Equipment: Require to Attend

Volleyball Required Apparel and  Equipment:
-Water bottle
-Volleyball or Running Shoes (No black soles)
-T shirt and Athletic Shorts/Pants
-Medical Devices (Braces, Inhaler, etc.)

Basketball Required Apparel and  Equipment:
-Water bottle
-Basketball Shoes (No black soles)
-T shirt and Athletic Shorts/Pants
-Medical Devices (Braces, Inhaler, etc.)
Child's Information
Child's First Name: *
Child's Last Name: *
Confirm the Mid School- Spring Recreational Event your child will be attending below? *
Required
Child's Grade *
Does your child have asthma? *
Does your child have any severe allergies to food or medications?
Leave the space "Blank" if this question does not relate to your child.
Is your child a current 21st Century Public Academy student? *
Parent's Information
First Name: *
Last Name: *
Phone Number: *
Email Address: *
Emergency Contact Information with Authorization to Pick Up:
List an individual other than parent/legal guardian to be contacted in case of emergency; must be local and have permission to pick up your child.
Emergency Contact Name: *
Phone Number: *
Waivers- (Required for participation)
21st Century Release Waiver:  
21st CPA COVID- 19 Waiver Disclaimer
Parent(s)/ Guardian(s) acknowledge that they have carefully read the above  Spring Recreational Event Release and COVID-19 Waiver Disclaimer and that they agree to its terms. *
Concussion In Sports (Fact Sheet)-  https://www.nmact.org/file/Facts_4_Families.pdf
Click the above web address (URL) to preview.
I understand while participating in this activity, my (child/participant) may be photographed. I agree to allow my (child/participant) photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. *
Type in your Full Name below:  Signature *
It is understood that you (Parent/Guardian) read and have agreed to all terms within the Release Waiver, COVID-19 Waiver,  Photo Release Waiver and Concussion Fact Sheet Document, by typing your full name in the space below.
Note:  There will be no refunds given once Spring Recreational Events,  clinic, camps, or competitions starts.  There will be no refunds if a child becomes sick or injured during recreational event, clinics, camps, or competitions.
Time and dates may/can change due to facility availability, weather, or unforeseen circumstances.  
A copy of your responses will be emailed to the address you provided.
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