Mid-Town Sports Winter Basketball League 2019 for Ages 5-11
Early Bird Rate: $30 per child if registered by Nov. 19
Regular Rate: $35 per child if registered between Nov. 20 - Dec. 14
(second child in household is $5 off)

A ministry of Middletown Church of the Nazarene
698 N. 5th St. Middletown, IN 47356
Contact us at (765) 354-2327 or middletownnaz@gmail.com

Email address *
Parent / Guardian Name (s) *
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Yes, I am interested in volunteering with this league (check all that may apply)
Phone # *
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Email
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Child #1 Name *
Your answer
Child # 1 Age (as of 1/1/19) *
Child #1 T-Shirt Size *
Child #2 Name
Your answer
Child # 2 Age (as of 1/1/19)
Child #2 T-Shirt Size
I understand that I will have to pay registration fees in full by 12/14/18 for my child to participate ($30 if registered by Nov. 19, $35 if registered between Nov. 20 - Dec. 14). I understand this payment may be submitted online at www.middletownnaz.com, as well as by mailing to or bringing to the church office at 698 N. 5th St. Middletown, IN 47356. I understand that this league will run on Saturdays from January 19 - February 23, 2019 and that I will be contacted by a coach regarding practice times by January 11. *
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A copy of your responses will be emailed to the address you provided.
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