Eagle Mountain REC

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Eagle Mountain REC

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RECEIPT: 2634 Congratulations! Your registration(s) are complete.

Your Business Name Branch Name City, State (123) 456-7890

1 Kindergartners Coed Shane Hansen Date: 10/03/2011 to 11/07/2011 Eagle Mountain City Youth Sports 2012 Jr. Jazz Basketball Registration Deadline is November 14, 2011 *TO RECEIVE DISCOUNTS, YOU MUST REGISTER AT CITY HALL*

47.00

To the right is your itemized receipt. Below are your individual Activity Waivers with important activity details.

Register online at www.eaglemountaincity.com or in person at City Hall, 1650 East Stagecoach Run Monday - Friday 7:30am to 5:30pm. League Information League.............................. Jr. Jazz Basketball Where............................... Eagle Mountain City Elementary Schools Season.............................. January - March 2012 Practices........................... Will be determined by the coaches Game Days.......................Saturdays and weekdays Grades Eligible..................K4th Grade (Coed) 5th - 6th (Boys & Girls) Fee................................. .$45.00 $5.00 discount per player if three or more register* $10.00 discount if player uses last year's jersey* *To receive Discounts you must register at City Hall. Registration includes 8 games, Utah Jazz Jersey, *one Utah Jazz game ticket, *a Utah Jazz team picture, a Certificate of Participation and Participation Award, a Jr. Jazz discount card and a Jazz player appearance. *Depending upon if there is a 2011-2012 NBA season. Coaches meeting will be on December 15th @ 7:00pm. Coaches will need to attend to

https://www.activityreg.com/receipt.wcs

10/4/2011

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receive their roster, equipment and rules. Registration Information Dates............................... .October 3 - November 7, 2011 Late Registration...............November 8- November Fee...........................$5.00 Registration after November 14 is subject to league size; there are no guarantees. Refunds........................$10 administration Fee for any refunds Visit the City website for information: .

VI...8108 Auth:310228 Courtney A Hansen

Total: Paid CC:

---------47.00 -47.00 ---------0.00

Change:

10/04/2011 11:01:59 AM 2634 INTERNET 437 THANK YOU!

Eagle Mountain REC 1650 E. Stagecoach Rd Eagle Mountain City, UT 84005 (801) 789-6694 ACTIVITY REGISTRATION

RECEIPT 2634 10/04/2011 5107 INTERNET

Name: Shane Hansen Address: 3986 Mt Airey Dr Eagle Mountain, UT 84005 Phone: (801) 310-5342 Age: 4 Fee Details: Activity: Date/Time: Activity Fee: $47 Kindergartners Coed 10/03/2011 - 11/07/2011 Eagle Mountain City Youth Sports 2012 Jr. Jazz Basketball Registration Deadline is November 14, 2011 *TO RECEIVE DISCOUNTS, YOU MUST

Fee: Tax Amount Due: Paid: Balance: Paid By:

$47.00 0.00 47.00 -47.00 0.00 Credit Card

https://www.activityreg.com/receipt.wcs

10/4/2011

Eagle Mountain REC

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REGISTER AT CITY HALL* Register online at www.eaglemountaincity.com or in person at City Hall, 1650 East Stagecoach Run Monday - Friday 7:30am to 5:30pm. League Information League..............................Jr. Jazz Basketball Where...............................Eagle Mountain City Elementary Schools Season..............................January - March 2012 Practices...........................Will be determined by the coaches Game Days.......................Saturdays and weekdays Grades Eligible..................K- 4th Grade (Coed) 5th - 6th (Boys & Girls) Fee..................................$45.00 $5.00 discount per player if three or more register* $10.00 discount if player uses last year's jersey* *To receive Discounts you must register at City Hall. Registration includes 8 games, Utah Jazz Jersey, *one Utah Jazz game ticket, *a Utah Jazz team picture, a Certificate of Participation and Participation Award, a Jr. Jazz discount card and a Jazz player appearance. *Depending upon if there is a 2011-2012 NBA season. Coaches meeting will be on December 15th @ 7:00pm. Coaches will need to attend to receive their roster, equipment and rules. Registration Information Dates................................October 3 - November 7, 2011 Late Registration...............November 8- November 14, 2011 Late Fee...........................$5.00 Registration after November 14 is subject to league size; there are no guarantees. Refunds........................$10 administration Fee for any refunds Visit the City website for information: www.eaglemountaincity.com. PARENTAL STATEMENT OF AGREEMENT I am willing to let my child/myself participate in the Eagle Mountain City Sports Program and hereby certify that my child/myself is in normal health and capable of participating safely in said program and has accident and health insurance. I hereby release and forever discharge Eagle Mountain City, a Corporation, its officers, employees, volunteers and all participating agencies and personnel from any and all claims and liability, present, and future, arising out of property damage or personal injury sustained as a result of my child or myself participating in this program. I hereby autherize the directors and volunteers of the Sports Program and of other participate agencies to act in my child's or myself's behalf in accordance with their best judgment in case of emergency. I give consent for said personnel to call for an ambulance or for medical or dental care in an emergency situation where the conditions of the said player represents serious or imminent threat to notify me prior to such action, and the expense if any will be borne by me. I understand that this activity and its components may contain elements of risk, of personal injury to my child or myself while participating in the Eagle Mountain City Sports Program. I understand that my child or myself can be removed from this program and any other Eagle Mountain City Program without a refund if my child or myself can not conduct ourselves in a sportsmanship like manner. The removal of my child or myself will be up to the descretion of the Sports Board and a fair hearing will take place to determine the type of action to take place, I hereby state that all "Participant Information" is correct. Any falsification of the above "Participant Information" will be grounds for the stated participant's removal from this program. Participant Agreed To Above Waiver During Online Registration Process. Print This Receipt For Your Records.

https://www.activityreg.com/receipt.wcs

10/4/2011