4th, 5th & 6th grade


Forms need to be turned into the Middle School office no later than Oct. 23rd ,2018.For more information contact Deon Birkes @ 479-790-7107 or 479-824-7447 or @




Home Phone:___________________Work:_________________Cell:____________





***In case of emergency and Parent/Guardian cannot be reached please contact:

Name:__________________________________Relationship to Student:__________

Emergency Phone:____________________________

For office use only

Jersey Size:   YS  YM  YL  YXL  S  M  L  XL                 Jersey #__________

Short Size:   YS  YM  YL  YXL  S  M  L  XL                   Jersey #__________


Registration Fee is $25.00. Please make checks payable to Lincoln Peewee Booster Club. The booster club will provide uniforms. Uniforms MUST be returned to the coordinator or team coach at the end of the year or if a player moves or quits before the season ends. **Damaged or Lost uniforms are the responsibility of the parents/guardians and players and will be replaced (shorts $25 and Jerseys $35) at cost to parent/guardian.

The Parent/Guardian is responsible for supplying game shoes for the child. EACH PLAYER MUST HAVE A PAIR OF ATHLETIC SHOES THAT ARE WORN EXCLUSIVELY IN THE GYMS. (If there is a problem please contact us.)

We will be playing in a League with other school districts from the area. Games (except tournaments) will be played on Saturdays. Typically, each team plays 8-10 regular season games and then a district tournament at the end of the season (February).

The league requires that we have an “A” and “B” team for each grade, both boys and girls. Attendance at practices is imperative as decisions on team placement will be made primarily from observation of the players during that time.


___I/We the parents/guardian of the above player herby agree to provide my/our approval to participate in any and all youth basketball activities and understand that we are responsible for all transportation and agree to pick up your child in a timely manner at practices and games.

___I I/We the parents/guardians of the above player herby agree to model a positive attitude during games and practices and to encourage fair play.

___I I/We the parents/guardians of the above player understand that I/We might forfeit my/our right to observe the games and or practices as determined by the coordinator, if I/WE do not model a positive attitude during games/practices.


Player signature: _____________________________________date:_________


Parent/Guardian: _____________________________________date:_________

Date received : _________         Cash________                Check#________