Youth Sports Form

Please provide as much information as possible, so we can tailor our outreach to your child’s needs and interests.

* Required fields

Child’s Information: *First Name: Middle Initial: *Last Name: *Street Address: Apartment: *Borough: *Zip Code: *School: *Date of Birth: *Any medical conditions? If so, please specify here. If none, please write “None.”:

Emergency Contact: *First Name: Middle Initial: *Last Name: *Street Address: Apartment: *Borough: *Zip Code: *Home Phone: – – Work/Other Phone: – – Cell Phone: – – *Email address: *Relationship to Child:

Interests

*Please specify which sports interest your child by checking the box(es) below.

Baseball Basketball Flag Football Lacrosse Soccer Softball Other:

Recreation Center Memberships:

Please type Yes or No in response to the following:

*Are you a member of a City of New York Parks & Recreation Center? If yes, please select your center: *Is your child a member? If yes, please select his/her center:

Youth Sports Form

Programs