OPEN SPACE AND RECREATION PLAN BRECKNOCK TOWNSHIP BERKS COUNTY
Greenwich Township Recreation Commission...FEB 7TH 6pm-8pm SMS Or register by mail: GTRC, 321...
Transcript of Greenwich Township Recreation Commission...FEB 7TH 6pm-8pm SMS Or register by mail: GTRC, 321...
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Nov
VIEW OUR NEWSLETTER AND ACCESS FORMS
GREENWICH TWP.:
http://www.greenwichtownship.org/gtrc/index.html
OR
GREENWICH TWP. SCHOOL DISTRICT:
http://www.gtsd.net/pub/
“COMMUNITY LINKS”
GREENWICH TOWNSHIP
RECREATION
COMMISSION
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Greenwich Township Recreation Commission 321 Greenwich Street Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 www.greenwichtownship.com/gtrc
January 10, 2011 Greenwich Township Residents:
As the new president of Greenwich Township Recreation Commission, I say, Welcome to 2011!
As many of you already know, the GTRC has undergone some Rec Board membership changes. Dan Perez and Bob Hurte have resigned from the Rec Board. They have both served our community for 10+ years with hard work, caring hands and always making decisions based on the philosophy of “THIS IS FOR THE KIDS”. Dan, Bob, we all thank you from the bottom of our hearts for all you’ve done for the kids and this community! We wish you much success in your future endeavors. At this time I’d like to introduce you to the 2011 GTRC Board Members: President: Angie Crosby Vice President: Jim Mangiola Secretary: Linda Oswald Treasurer: Wayne Moser Commissioner: Craig Patterson Commissioner: Mike Boures Commissioner: Mark Helman 1st Alternate: George Howell 2nd Alternate: Vacant Each member is committed to continue the philosophy of “THIS IS FOR THE KIDS”. I would also like to thank all the volunteers that have stepped up to run our programs for 2011-2012 Adult Basketball-Fri nites-Mike DiMarco Adult Basketball-league-Greg Dudek CBL Basketball, 3-on-3, Hoop Kids-Dave Glenn Baseball-Chris Figler Cheerleading-Barbara Wynston &Christine Mundy Dances-Cathy Husek Field Hockey-Denise Aylward Golf-George Howell Lacrosse-boys-Dave Clampitt/Brian Cenci Lacrosse-girls-Elaine Marhold Movie Night-Nancy Schmidt Ski Club-Rick Gengaro Soccer-Rob Anselmo Softball-Tim Hoey Wrestling -Al Parente Wrestling Tournament-Al Parente/Jeff Oswald Booster Club-Linda Oswald Flag Football- Volunteer needed
And we must not forget to thank all those “behind the scenes” folks that give of their time and share the spirit of “fun” for our community.
THANK YOU SO MUCH….YOU MAKE IT HAPPEN!
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Greenwich Township
Recreation Commission
Spring Activities and Sports
Greenwich Township Recreation Meeting……………………..………………..Monthly CHANGE Meetings held the THIRD WEDNESDAY of each month.
Time & Location: 7:00 p.m. Greenwich Township Municipal Building
All are encouraged to attend!
Township Easter Egg Hunt……………………………..…… Details coming soon
Annual Sports Banquet………………………………….…… Details coming soon Honoring Sport Participants in Grades 3 through 8 Invitations will be mailed mid-March.
Location: Bloomsbury Banquet Hall
2011 Recreation Sponsored Dances………………….…………….………….Monthly Feb 4th, Apr 1st, May 6th, and June 3rd Grades 6 through 8 only Location: Stewartsville Middle School multipurpose room
Time: 7-10 pm
Upcoming Registrations for
Baseball-Softball-:
SATURDAY MORNINGS AT SMS
WEEKNIGHTS:
JAN 15TH 9am-11am
JAN 18TH 6pm-8pm GES
JAN 22TH 10am-12pm
JAN 24TH 6pm-8pm SMS
JAN 29TH 11am-1pm
JAN 25TH 7pm-9pm GES
FEB 12TH 10am-12pm
JAN 31ST 7pm-9pm SMS
FEB 7TH 6pm-8pm SMS
Or register by mail: GTRC, 321 Greenwich Street, Stewartsville, NJ 08886
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Greenwich Township Recreation Commission
Presents the 2011
TBD
The hunt will be open to children infant to 5th Grade.
Come join the fun!
Volunteers needed! Please contact:
George Howell at [email protected]
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Greenwich Township Recreation Commission
Announces Registration for
REGISTRATION DATES:
SATURDAY MORNINGS AT SMS
WEEKNIGHTS:
JAN 15TH 9am-11am
JAN 18TH 6pm-8pm GES
JAN 22TH 10am-12pm
JAN 24TH 6pm-8pm SMS
JAN 29TH 11am-1pm
JAN 25TH 7pm-9pm GES
FEB 12TH 10am-12pm
JAN 31ST 7pm-9pm SMS
FEB 7TH 6pm-8pm SMS
Or register by mail: GTRC, 321 Greenwich Street, Stewartsville, NJ 08886
C10t10COACHES NEEDED!!!
Please complete both the coaches and the “Mind Your business” applications by January 31st in order to be
considered for a coaching position. This includes returning coaches from last season.
Questions: Please contact Tom Hoey at 908-387-6761 or [email protected]
Pony Level
1st & 2
nd grade
Instructional Level
Coach pitched “soft” ball
Rosters created by a lottery selection process
FEE: $50
Midget Level
L
Biddy Level
3rd
& 4th
grade
League play with surrounding towns, competitive
Player pitched softball
FEE: $60
Junior Level
7th
& 8th
grade
League play with surrounding towns, competitive
Player pitched softball
FEE: $65
Midget Level
5th
& 6th
grade
League play with surrounding towns, competitive
Player pitched softball
FEE: $60
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Greenwich Township Recreation Commission Announces Registration for
REGISTRATION DATES:
SATURDAY MORNINGS AT SMS JAN 15TH 9am-11am JAN 22TH 10am-12pm JAN 29TH 11am-1pm FEB 12TH 10am-12pm
WEEKNIGHTS: JAN 18TH 6pm-8pm GES JAN 24TH 6pm-8pm SMS JAN 25TH 7pm-9pm GES JAN 31ST 7pm-9pm SMS FEB 7TH 6pm-8pm SMS
Or register by mail: GTRC, 321 Greenwich Street, Stewartsville, NJ 08886
TEE BALL
Instructional Play
Rosters created by a lottery selection process
Boys & girls ages 5-6 as of 4/30/11
Fee $40
ROOKIES
League play with surrounding towns instructional
Rules designed for coach pitched hardball baseball
Rosters created on an evaluation draft process
Boys ages 7-8 as of 4/30/11
*Optional 8 year old tournament team selection for
Cal Ripken district tournament
Fee $50
MINORS
League play with surrounding towns, competitive
Player pitched hardball baseball
Rosters created on an evaluation draft process
Boys ages 9-10 as of 4/30/11
*Tournament selection team to participant in
10U Cal Ripken district tournament as well as various
area tournaments/travel leagues
Fee: $50
MAJORS
League play with surrounding towns, competitive
Player pitched hardball baseball
Rosters created on an evaluation draft process
Boys ages 11-12 as of 4/30/11
*Tournament selection team to participant in
12U Cal Ripken district tournament as well as various
area tournaments/travel leagues
Fee: $55
JUNIORS
League play with surrounding towns, competitive
Player pitched hardball baseball
Rosters created on an evaluation draft process
Boys ages 13-15 as of 4/30/11
*Tournament selection team to participant in 14U Cal Ripken
district tournament as well as various area tournaments/travel
leagues
Fee: $60
Tee Ball rosters are set by lottery basis. Rookie, Minor, Major and Junior rosters based on an evaluative draft.
*Any player that makes tournament selection team will need to supply a copy of child’s birth certificate.
COACHES and UMPIRES NEEDED!!!
Please complete both the coaches and the “Mind Your business” applications by January 31st in order to be considered for a coaching
position. This includes returning coaches from last season.
Questions: email [email protected]
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PHILLIPSBURG “STATELINER” AREA LACROSSE
Most popular in North America, lacrosse is Canada’s national summer sport. It has grown in popularity in the United
States, becoming the fastest growing sport at the high school and NCAA levels.
Greenwich Township Recreational Committee (GTRC) will again manage both a boys’ and girls’ lacrosse league in the
Spring of 2011. The GTRC’s goal is for children from all cluster schools to learn the fun and fast game of lacrosse.
What Ages Levels can participate in the Phillipsburg Area Lacrosse League?
For competitive teams, the age levels for lacrosse will be from 3rd grade to 8th grade.
In addition, the lacrosse program has an new instructional level for 1st and 2
nd graders (called Little Liners). This
program will be open to both boys and girls with the goal of teaching young players basic skills. The program will be
held on 8 weekends in the spring.
If My Child wants to Play Lacrosse, what Type of Equipment will He/She Need to
Purchase?
For girls, they need to supply their own lacrosse stick, goggles and a mouth piece.
For boys, they wear helmets, shoulder and arm pads and gloves. This equipment will be supplied by the GTRC. Each
player will have to supply their own lacrosse stick and mouth piece. However, if you son has his own equipment, he can
participate in the program at a reduced registration fee (see attached sign-up sheet for 3 price levels)
For the Little Liner program, each player will need his/her own lacrosse stick and mouth guard.
Lacrosse is a team sport that is played with ten
players (men’s field) or twelve players (women’s
field), each of whom uses a netted stick in order
to pass and catch a hard rubber ball with the aim
of scoring by propelling the ball into the
opponent’s goal.
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GREENWICH TOWNSHIP RECREATION COMMISSION 321 Greenwich Street Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 www.greenwichtownship.com
Become Involved! Join Your Recreation Booster Club Today!
What is a Booster Club?
The booster club is a formal list of people that are willing to help support in any way in the many sports and activities we
have to offer. We have found that in most cases people are willing, and in fact, want to get involved if they are asked, but
often times the Recreation Commission does not know who to call. That is where the booster club comes in.
From your selection(s), the Recreation Commission can maintain a list of contact names for those specific
activities/events/sports you wish to play a more active role. You will be contacted by the committee chairperson, and be
able to help at whatever capacity is convenient for you. You determine your level of involvement dictated by your time
availability. Any and all help is greatly appreciated. Just mail your completed form to the above address.
Using the list below, please circle any and all areas that you or your spouse may be interested in providing assistance.
Even just one selected item will make a difference to a program. Please take a moment to look at all the programs we
offer and see where you can help.
Adult Basketball (Sept–May) Wrestling (Dec.) Baseball (Apr–June)
Community Day (Sept) Cheerleading (Nov-Mar) Sports Picnic (June)
Field Hockey (Sept-Nov) Youth Basketball (Nov-Mar) Golf (June-Aug)
Soccer (Sept-Nov) Easter Egg Hunt (April) Summer Flag Football (June-July)
Halloween Parade
(Oct) Sports Banquet (Apr-May) Equipment/Uniform (as needed)
Dance Chaperone
(school year) Lacrosse (Apr-June) Concession Stand (as needed)
Softball (Apr-June)
Please print clearly.
Name ______________________________________________________
Address ____________________________________________________
Email Address _______________________________________________
Home Phone_____________________ Cell Phone ________________
NOTE: If a friend or neighbor does not have a school age child this year but would also like to be informed via this
packet, please include their name(s), address and phone number on the back of this sheet. Every effort will be made to
provide them with this and future informational packets.
Check here if additional names have been included on reverse side.
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GREENWICH TOWNSHIP RECREATION COMMISSION
OFFERS
Community Service Hours for
Greenwich Resident Teens
GTRC is seeking Teens 14* years and older to provide community service hours for several events. GTRC is seeking individuals who have a positive attitude, are responsible, reliable and enjoys working with youths of all ages.
If you are interested and meet these requirements, please sign up for events and/or activities listed below. Applications must be received during registration openings
For 2011-20121
Interested, Place an “X”
Activity / Sport Date
Community Day Dates to be determined (Sat.)
Rain date (Sun.) Halloween Parade Dates to be determined (Sat.)
Snack Stand Dates to be determined (Jan.)
Easter Egg Hunt Dates to be determined (April)
Sports Picnic Dates to be determined (June)
*The age may be adjusted based on feedback and assignments
1You will be contacted of specific dates as event or activity is approaching
Please provide:
Name:_______________________________________ Age:_____________________ Address:_______________________________________________________________
Phone numbers: Home______________________ Cell _________________________ Organization for which community service hours are collected: ______________________________________________________________________
Parent’s Name:__________________________________________________________
Phone numbers: Home______________________ Cell __________________________ Parent’s signature approving your work toward community service hours with the Greenwich
Township Recreation Commission is required.
Parent’s signature: ______________________________________ Date:___________
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GREENWICH TOWNSHIP RECREATION COMMISSION
REGISTRATION 321 Greenwich Street, Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 Web site: www.greenwichtownship.com/gtrc
CHILD’S NAME:______________________________________________ BIRTHDATE___/___/___AGE_____ M F
Cell: _________________________________________
PARENT/GUARDIAN:_________________________________________ PHONE Home:__________________________
ADDRESS:___________________________________________________________SCHOOL:______________________
Street City/Town Zip
EMAIL ADDRESS: ______________________________________________SPRING 2011 GRADE: ________________
Did you play last year? Yes No If yes, name of coach:__________________________________________
Are you involved in any other activity(s)/sport(s) that will prevent you from attending games/practices? Yes No If yes, please indicate activity/sport and day(s) of the week_______________________________________
Circle CHILD’s SHIRT size Y-S, Y-M, Y-L or A-S, A-M, A-L, A-XL SHORT/PANT size Y-S, Y-M, Y-L or A-S, A-M, A-L, A-XL (6-8) (10-12) (14-16) (6-8) (10-12) (14-16)
Have you ever played baseball/softball for another Phillipsburg area organization? (Holy Name, Alpha, Lopatcong, etc.)
Yes No If yes, please indicate name of Organization______________________________________________
Registering for the following (discounts apply to families registering more than 2 children---ask for details)
SOFTBALL: Pony $50 Biddy $60 Midget $60 Junior $65
BASEBALL: Tee Ball*$40 Rookie* $50 Minor $50 Major $55 Junior $60
Baseball only: Check box if would like to be evaluated for tournament selection team at circled level.
Please make checks payable to: GTRC LATE FEE (applicable after Feb. 15th, 2011): $30/child
*Parents are not required to work the snack stand for the sports with an asterisk.
PARENTAL/GUARDIAN CONSENT
My child has parental/guardian consent to participate in the Greenwich Recreation Commission’s recreation programs for the 2010
season. The fee that is required at registration time is for individual secondary insurance coverage, equipment and other related costs.
This fee must be paid and this consent form must be signed before a child is allowed on the practice field and issued a uniform. Also,
there will be NO REFUNDS of registration fees after any teams’ first practice.
As a consenting parent/guardian, I agree to take proper care of any recreational equipment and uniform loaned to my child during the
season. I also promise to deliver the equipment and uniform to the coach or designee in good condition and appropriately cleaned at
the end of the season. I understand that if I do not turn in any equipment or uniform at the end of the season, I will be billed for the
cost of said equipment/uniform. In addition, I agree to abide by all Greenwich recreational rules and the rules for the league in which
my child participates.
Transfers are recognized to be counterproductive to the programs of GTRC. Transfers to teams in other municipalities which
participate in the same league shall not be granted except in the case of extenuating circumstances. Any player granted a transfer to
another municipality may be ineligible to play for any Greenwich sport team for a period of one full calendar year. Transfers are
subject to League Approval
I, as parent of a child/children participating in the GTRC recreation program, will attend a Code of Conduct seminar
sponsored by the GTRC.
By my signature, I understand and accept all the conditions stated above.
Parent/Guardian’s Signature:________________________________________________________________________Date:___________________
RECREATION USE ONLY:
Cash/Check#:________ Amount Paid:_________ Late fee: Buyout: Rec’d by:________________
Discounts applied: Y N Paying for siblings or more than one sport Y N How many? ___________________
Snack Stand Buyout (optional): The GTRC relies on revenue from Snack Stand sales for fundraising. It is expected that all
parents will work the Snack Stand at sometime during the season. If you prefer not to work the Snack Stand, you can pay a
“buyout” fee of $100 per child. NOTE: If you opt not to buyout and do not fulfill your obligation, a $100 charge will be assessed.
I choose to (check one): Work the snack stand Purchase the buyout
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GREENWICH TOWNSHIP RECREATION COMMISSION
REGISTRATION 321 Greenwich Street, Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 Web site: www.greenwichtownship.com/gtrc
PHILLIPSBURG AREA LITTLE LINERS LACROSSE
REGISTRATION – SPRING 2011
COED 1ST
& 2ND
GRADE
CHILD’S NAME:______________________________________________ BIRTHDATE___/___/___AGE_____ M F
Cell: _________________________________________
PARENT/GUARDIAN:_________________________________________ PHONE Home:__________________________
ADDRESS:___________________________________________________________SCHOOL:______________________
Street City/Town Zip
EMAIL ADDRESS: ______________________________________________SPRING 2011 GRADE: ________________
Your child wears the following size t-shirt (please circle one): Youth Small / Youth Medium / Youth Large /
Adult Small
FEES: $25
Please make checks payable to: GTR C LATE FEE (applicable after Feb. 15, 2011): $10/child
IMPORTANT INFORMATION
Little Liners lacrosse program will be formed for first and second graders. This program is instructional only and will be designed to
teach players the basics lacrosse skills. Players that register late may not be placed on teams or may have to start late, due to the
ordering of mandatory equipment for practices/games. All lacrosse equipment will be supplied by the GTRC except for lacrosse sticks
and mouth guards. Each player is required to have their own lacrosse stick and mouth guard.
PARENTAL/GUARDIAN CONSENT
My chi ld has parental /guard ian consent to par t icipa te in the Greenwich Recrea tion Co mmission’s l acrosse
program for the 2011 season. The fee tha t i s requi red a t regi strat ion t ime i s for individual secondary
insurance coverage, equipment and o ther rela ted costs. This fee must be paid and this consent fo rm must be
signed before a chi ld i s al lo wed on the p rac tice f ield . Also, there wil l be NO REFUNDS of registration
fees after any tea ms’ f irst practice.
As a consenting parent/guardian, I agree to take proper care of any recreational equipment and uniform loaned to my child during the
season. I also promise to deliver the equipment to the coach or designee in good condition and appropriately cleaned at the end of the
season. I understand that if I do not turn in any equipment or uniform at the end of the season, I will be billed for the cost of said
equipment/uniform. In addition, I agree to abide by all League Rules.
Please be informed that any child, who leaves the GTRC lacrosse program to play for another organization that competes in the
same league, will be ineligible to play sports for GTRC for one full year.
By my s ignature, I understand and accept al l the co ndit ions sta ted above .
Parent/Guardian’s Signature:___________________________________________Date:________________
RECREATION USE ONLY:
Cash/Check#:________ Amount Paid:_________ Late fee: Buyout: Rec’d by:________________
Discounts applied: Y N Paying for siblings or more than one sport Y N How many? ___________________
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GREENWICH TOWNSHIP RECREATION COMMISSION
REGISTRATION 321 Greenwich Street, Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 Web site: www.greenwichtownship.com/gtrc
PHILLIPSBURG AREA BOYS LACROSSE REGISTRATION – SPRING 2011
3rd
GRADE – 8th
GRADE
CHILD’S NAME:______________________________________________ BIRTHDATE___/___/___AGE_____ M F
Cell: _________________________________________
PARENT/GUARDIAN:_________________________________________ PHONE Home:__________________________
ADDRESS:___________________________________________________________SCHOOL:______________________
Street City/Town Zip
EMAIL ADDRESS: ______________________________________________SPRING 2011 GRADE: ________________
FEES:
$150 (my son needs GTRC supplied la crosse equipment – he lmet, shoulder , arm pads and gloves) . My
son has his own lacrosse st ick.
$125 (my son needs GTRC supplied lacrosse equipment – he lmet, shoulder & arm pads) . My son has his
own lacrosse st ick and gloves.
$75 (my son has his own lacrosse equipment – he lmet, shoulder & arm pads, gloves) . A p lay must have
al l o f this equip ment to rece ive this discount regis tra t ion fee.
Please make checks payable to: GTR C LATE FEE (applicable after Feb. 15, 2011): $25/child
IMPORTANT INFORMATION
Players that register late may not be placed on teams if the rosters are full or may have to start late, due to the ordering of mandatory
equipment for practices/games. All lacrosse equipment will be supplied by the GTRC (unless parent’s indicate above that their son has
his own equipment) except for lacrosse sticks and mouth guards. Each player is required to have his own lacrosse stick (except for
goalie) and mouth guard.
PARENTAL/GUARDIAN CONSENT
My chi ld has pa rental /guard ian consent to par t icipa te in the Greenwich Recrea tion Co mmission’s l acrosse
program for the 2011 season. The fee tha t i s requi red a t registrat ion t ime i s for individual secondary
insurance coverage, equipment and o ther rela ted costs. This fe e must be paid and this consent fo rm must be
signed before a chi ld i s al lo wed on the p rac tice f ield and issued a uni form. Also , there wi l l be NO
REFUNDS of regis tra t ion fees a f ter any teams’ f irs t pract ice .
As a consenting parent/guardian, I agree to take proper care of any recreational equipment and uniform loaned to my child during the
season. I also promise to deliver the equipment and uniform to the coach or designee in good condition and appropriately cleaned at the
end of the season. I understand that if I do not turn in any equipment or uniform at the end of the season, I will be billed for the cost of
said equipment/uniform. In addition, I agree to abide by all League Rules.
Please be informed that any child, who leaves the GTRC lacrosse program to play for another organization that competes in the
same league, will be ineligible to play sports for GTRC for one full year.
By my s ignature, I understand and accept al l the condit ions sta ted above .
Parent/Guardian’s Signature:___________________________________________Date:________________
RECREATION USE ONLY:
Cash/Check#:________ Amount Paid:_________ Late fee: Buyout: Rec’d by:________________
Discounts applied: Y N Paying for siblings or more than one sport Y N How many? ___________________
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GREENWICH RECREATION MEDICAL CONSENT FORM 2011
A medical consent form must be completed for every sport registered
(discounts apply to families registering more than 2 children---ask for details)
NAME:__________________________________________ BIRTHDATE____/____/____ AGE____ M F
PARENT/GUARDIAN:_________________________________ EMAIL_____________________________
ADDRESS:___________________________________________________ ___________________________
(H) PHONE__________________ (W) PHONE____________________ ( C ) PHONE___________________
Family Physician’s Name:_______________________________ Phone #:_____________________________
Insurance Coverage:
Company Name:_______________________________________Policy #:_____________________________
Emergency Contact: (Can be a parent)
Name:____________________________________________________
Phone:____________________________________________________
Relationship to child:________________________________________
The undersigned releases from any liability, the coaches and any other person associated with the Greenwich
Township Recreation Program for any expenses, charges or other costs or claims for damages or injury arising
from participation in any program.
The undersigned is aware of the potential for physical injury during actual participation in and during the
transportation to and from the program. The undersigned guarantees that the participant is appropriately
covered by a primary medical insurance policy as specified above.
The undersigned acknowledges that the emergency contact listed on this form is authorized to act on behalf of
the parent/guardian for any unexpected medical and/or hospital care in an emergency situation, excluding major
elective surgery, for the above named minor during the period of the parent/guardian’s absence.
Signature of Parent/Guardian:____________________________________Date:______________________
***IMPORTANT – PLEASE READ AND COMPLETE***
Does your child have any allergies or medical conditions that your coach should be aware of? If so, please note
here along with any medications currently being taken:
______________________________________________________________________________________
______________________________________________________________________________________
Coaches: To be verified by parent/guardian within first week of practice.
Parent/Guardian verification Signature ________________________
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COMMISSION
Baseball Umpires
UMPIRES INFORMATION/CONSENT FORM
PLEASE PRINT CLEARLY
NAME
ADDRESS
PHONE (Home) PHONE (Cell)
SS #
UMPIRING HISTORY (LAST 5 YEARS – please list organization, city & state)
DIVISIONS (Please circle the level(s) at which you are interested in umpiring)
BASEBALL: Rookies Minors
(Ages 7 & 8) (Ages 9 & 10)
Please provide one reference with phone number (mandatory):
Signed: __________________________________________ Date: ___________________________
Note: Prospective umpires who are 18 years of age and older must also complete the Little League Volunteer Application
form. Those less than 18 need only fill out this form.
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Greenwich Township Recreation Commission 321 Greenwich Street Stewartsville, NJ 08886
Rec Hotline: (908) 859-1712 www.greenwichtownship.com
COACH’S APPLICATION
PLEASE print clearly and use one form per applicant. Mail completed form to the address above. NOTE: Applications must be received by all interested coaches no later than specified date on the respective sport registration form.
NAME
ADDRESS ______________________________________________________________________________________
SS# ____________________________________________ CELL PHONE _______________________________
PHONE (Home) PHONE (Cell)
FAX (Home)
Can this e-mail address be used as the primary way of communication. (i.e.: scheduling changes etc.)
YES NO
If your response is NO, which means of communication would be best:______________________________________
COACHING HISTORY (LAST 5 YEARS – please list organization, city & state) Please attach additional sheet if necessary.
SHIRT SIZE _________
Sport ______________ Level (age) ___________ Preference: HEAD ASSISTANT EITHER
Sport ______________ Level (age) ___________ Preference: HEAD ASSISTANT EITHER
Sport ______________ Level (age) ___________ Preference: HEAD ASSISTANT EITHER
Please provide one reference with phone number (mandatory):
________________________________________________________________________________________________________
I certify that all of this information is true and that by volunteering to coach in Greenwich Township, I give my consent to have a
background check done in accordance with the “Volunteers for Children Act”.
Signed: ______________________________________________________________ Date: _________________________
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MIND YOUR BUSINESS, INC.
AUTHORIZATION AND RELEASE FOR THE PROCUREMENT
OF A INVESTIGATIVE REPORT
I, the undersigned consumer, do hereby authorize _Greenwich Township Recreation Commission__, by and through its independent
contractor, MIND YOUR BUSINESS, INC. (“MYB”), to procure an investigative report on me.
These above mentioned reports may include, but are not limited to, employment and education verification; personal references;
citations; a social security number verification; present and former addresses; criminal and civil history/record; and any other public
record; and any other information bearing on my worthiness, character, general reputation, personal characteristics, trustworthiness
and/or mode of living.
I understand that the investigative consumer report I have authorized above may include information obtained by interviews with my
neighbors, friends and/or associates and/or others with whom I am acquainted or who may have knowledge concerning said
information. I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative
consumer report prepared on me upon written request to MYB that is made within a reasonable time after the date hereof.
I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the
same to _ Greenwich Township Recreation Commission _, by and through MYB, including but not limited to, any courthouse, any
public agency, any and all law enforcement agencies and any and all credit bureaus, regardless of whether such person, business entity
or governmental agency compiled the information itself or received it from other sources, including alcohol and controlled substance
information from previous employers.
I hereby release Greenwich Township Recreation Commission _, MYB and any and all persons, business
entities and governmental agencies, whether public or private, from any and all liability, claims and/or
demands, of whatever kind, to me, my heirs, or others making such claim or demand on my behalf, for
procuring, selling, providing, brokering, and/or assisting with the compilation or preparation of the
consumer report and/or investigative consumer report hereby authorized.
PRINTED NAME: ________________________________________________________________________________________
First Middle Last Maiden/Other (within past 7 years only)
SIGNATURE: _________________________________________ DATE:__________________________________
COMPLETE RESIDENCE ADDRESS:
___________________________________________________________________________________________________________
Street Number/P.O. Box Street Name
___________________________________________________________________________________________________________
City State Zip Code County
SOCIAL SECURITY NUMBER: ____________________________________________________________________________
DAYTIME TELEPHONE NUMBER: ____________________________________________________________________________
DRIVER’S LICENSE NUMBER: ________________________________________ STATE ISSUED: ______________
DATE OF BIRTH*: ________________________________________ GENDER*: ______________
Alternatively, you may elect to call MYB directly at (888) 758-3776 X9909 to leave your Date of Birth or Social Security Number.
* This information is voluntary. However, without this information, we will be unable to properly identify you in the event we
find adverse information during the course of our background search.
PLEASE LIST ALL ADDITIONAL RESIDENCES THAT YOU HAVE RESIDED IN THE PAST FIVE (5) YEARS:
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Street Number/P.O. Box Street Name City State Zip Code County
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Street Number/P.O. Box Street Name City State Zip Code County
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Street Number/P.O. Box Street Name City State Zip Code County