DEXTER PARKS AND RECREATION LITTLE LEAGUE FOOTBALL 2015 REGISTRATION FORM
TACKLE FOOTBALL PROGRAM JV League (3rd & 4th grade) Varsity League (5th & 6th grade)
Please Print Clearly:
Player’s Name: ___________________________________
Player : T-shirt size (circle one)
YOUTH SMALL
ADULT SMALL
rd
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Grade: 3 4 5 6 Birthday: ______/______/_________
YOUTH MEDIUM ADULT MEDIUM
(Starting in August 15-16 school year)
YOUTH LARGE
ADULT LARGE
ADULT XLARGE
Medical Condition: ______________________
Team Played on in 2014: BLACK BLUE RED GREEN
Weight: ________________ __________(initials ) ALL PLAYERS MUST BE PRESENT AT TIME OF
REGISTRATION TO BE WEIGHED USING THE DPR SCALES. PLAYERS MUST WEIGH-IN PRIOR TO
EACH GAME. For ball carrier positions weight limit for JV (3-4 grade) is 110 pounds, and Varsity
(5-6 grade) is 125 pounds. All players exceeding weight limit must play on the line.
Parent Shirt ($14 per shirt & must be paid w/registration)
_____ Youth Small
_____ Youth Medium
_____ Youth Large
_____ Adult Small
_____ Adult Medium
_____ Adult Large
_____ Adult XXLarge (+$2)
_____ Adult XXXLarge (+$2)
_____ Adult XLarge
________ Total
If you have a brother or sister playing in the same league, list their name so that they will be placed on
the same team:_______________________ Remember only brothers and sisters in the same household
will be placed on teams together. If you have a special circumstance, please contact the park office.
Parent/Guardian Information:
Name: ________________________________
Address: _______________________________
Phone: ________________________________
Email: ___________________________________
Relationship to child:_____________________
Check if interested in helping coach: ___________
Additional Parent Information:____________________________________________________________
We, as parents (guardians) of the above named child give our permission to his/her participation in this year’s program. We
assume all risks and hazards incidental to such participation in this program. We understand we are responsible for our child’s
transportation to and from games and practice and for the return of any uniform or borrowed equipment in our possession at
the end of the season. Signing below gives Department of Parks & Recreation of any registration implies that all participants are
specifically granting irrevocable permission to Parks & Recreation and its assigns, both during and any time after, to use their
likeness, name, voice, or words in either television, radio, film, newspaper, magazines, and other media, and in any form, for
the purpose of advertising or communicating the purposes and activities of the Department of Parks & Recreation.
X________________________________________________ Parent/Guardian Signature (required)
Registration Fee & Information: Fee: $55 per player. Fill out one form for each player. Registrations are taken at
the park office Monday-Friday 7:30am-4:30pm (closed during the noon hour). There will be an evening registration
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on Tuesday, August 18 from 5-7pm at the DPR sports complex. The evening registration will also be an equipment
fitting. Registration forms may be printed off of the website (www.dexterpark-rec.com ); online registration will
not be taken for football due to the fact all players must be weighed.
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THE DEADLINE TO REGISTER WILL BE Friday August 21 . DPR reserves the right to refuse forms that are received
after the deadline. No Refunds.
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Monday, August 24 EQUIPMENT WILL BE ISSUED; game schedules will be handed out also. Practices will be on
Tuesdays and Thursdays from 6-8pm at the sports complex. Coaches may add practice dates, and the week of the
fair, practice will not be at the complex.
Dexter Parks & Recreation Office: 573-624-8244 Fax: 573-624-5298
Email: [email protected]
Dexter Parks & Recreation website: www.dexterpark-rec.com
Find us on Facebook: Dexter Parks and Recreation
Sign up for text alerts at the Daily Statesman website: www.dailystatesman.com
If you have questions or concerns about DPR little league football please contact Gaston Orahood, Aquatic &
Recreation Programmer.
Tentative Game Schedule Dates: (pending finalization of DHS sports)
We are looking to start football games on September 12th and anticipating the final games being October 10th.
Most games will be on Saturday--teams will also have some night games during the week throughout the
season.
5-6 GRADE teams will travel and have home games. Teams we will be playing include but are not limited to
Jackson, Kennett, New Madrid, Malden, and Portageville.
3-4 GRADE teams most games will be played at Dexter. There are a couple of games we might play against
Jackson and New Madrid.
DPR CAMP: If you have registered for DPR football the camp is free and part of the program. DPR Camp will be a
1-day event later in August after the sign-up deadline. Please check our website and Facebook page for more
information.
Office use: Payment: $55 Cash debit/credit Check #_______ Initials: ______
Date:______________________