Unified Sports Skills Clinic Registration Form

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The Unified Club Sports Skills Clinic will run on 4 consecutive Thursdays (1/30, 2/6, 2/13, 2/20) at Willard Elementary School. We will begin at 7:00 pm, and pick up will be between 8:15 - 8:30 pm.

If you have any questions, please contact Mr. Rinaldi (rrinaldi@ridgewood.k12.nj.us) or Mr. Kilcullen (mkilcullen@ridgewood.k12.nj.us)

Name of participating student:

Name of parent or guardian:

Parent or guardian contact information: (phone number, email)

Emergency contact information: (name, phone number)

Have you completed the "Health History Update Questionnaire" Form?

Yes

Is there any medical information not already detailed on the form that you'd like to make our staff aware of?

My child has permission to participate at the Unified Sports Clinic

Yes

Which nights do you plan on attending? Check all that apply.

January 30

February 6

February 13

February 20

Media Release: Do we have permission to film or photograph your child for school-related purposes? (This is separate from documentary release, and would be used for school-related items like flyers, school newspaper, student projects etc.)

Yes

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