SIPlive: City of Sundance, Wyoming (L.?)

2019 Sundance Summer Recreation

For more information, please see the attached flyer

Parent/Guardian Contact Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:	Email:

T-Ball: May 30 - June 27. Ages: 4-5. (1:00pm - 2:00pm) Practices at the HS Field and Games will be TBA at the Baseball Complex . (Must be 4 by May 31)

Coach Pitch T-Ball: May 30 - June 27. Ages: 6-7. (1:00pm - 2:00pm) Practices at the HS Field and Games will be TBA at the Baseball Complex. 7 year olds must play coach pitch unless minors are in need of players

Minor or Major League Baseball: TBA $20.00

Soccer 1: (K-3rd) Wed., May 29 - June 26 (1:00pm - 2:00pm) HS Field

Soccer 2: (4th-7th) Wed., May 29 - June 26 (2:00pm - 3:00pm) HS Field

Basketball 1: (K-2nd) Tues/Thur., July 2, 11, 16, 18, 23 (1:00pm - 2:00pm) Central Gym

Basketball 2: (3rd-5th) Tues/Thur., July 2, 11, 16, 18, 23 (2:00pm - 3:00pm) Central Gym

Basketball 3: (6th-8th) Tues/Thur., July 2, 11, 16, 18, 23 (3:00pm - 4:00pm) Central Gym

Volleyball 1: (K-3rd) Mon., June 3 - July 1 (1:00pm - 2:00pm) Central Gym

Volleyball 2: (4th-5th) Mon., June 3 - July 1 (2:00pm - 3:00pm) Central Gym

Volleyball 3: (6th-9th) Mon., June 3 - July 1 (3:00pm - 4:00pm) Central Gym

T-Ball:

$15.00

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Age		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Age		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Age		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Age		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Age		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Age		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Age		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Age		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Age		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Age		[10]

Coach Pitch T-Ball:

$15.00

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Age		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Age		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Age		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Age		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Age		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Age		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Age		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Age		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Age		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Age		[10]

Minor or Major League Baseball:

$20.00

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]

Soccer 1:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Soccer 2:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Basketball 1:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Basketball 2:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Basketball 3:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Volleyball 1:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Volleyball 2:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Volleyball 3:

$7.50

Quantity:

Item Subtotal:

$0.00

Child's Name	[1]
Child's DOB (mm/dd/yyyy)	[1]
Child's Grade (next fall)		[1]
Child's Name	[2]
Child's DOB (mm/dd/yyyy)	[2]
Child's Grade (next fall)		[2]
Child's Name	[3]
Child's DOB (mm/dd/yyyy)	[3]
Child's Grade (next fall)		[3]
Child's Name	[4]
Child's DOB (mm/dd/yyyy)	[4]
Child's Grade (next fall)		[4]
Child's Name	[5]
Child's DOB (mm/dd/yyyy)	[5]
Child's Grade (next fall)		[5]
Child's Name	[6]
Child's DOB (mm/dd/yyyy)	[6]
Child's Grade (next fall)		[6]
Child's Name	[7]
Child's DOB (mm/dd/yyyy)	[7]
Child's Grade (next fall)		[7]
Child's Name	[8]
Child's DOB (mm/dd/yyyy)	[8]
Child's Grade (next fall)		[8]
Child's Name	[9]
Child's DOB (mm/dd/yyyy)	[9]
Child's Grade (next fall)		[9]
Child's Name	[10]
Child's DOB (mm/dd/yyyy)	[10]
Child's Grade (next fall)		[10]

Total:

$0.00

Please indicate below if the child/children listed on this form have an illness or disability that may require special attention during participation in the Summer Recreation Programs.

Please describe the illness or disability, if any.

Payment Information

Method of Payment:

Processing Fees:

Credit cards: 3% plus $0.25 ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks: $0.49

	Update name from Parent/Guardian Contact Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:

Credit Card Number:
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from Parent/Guardian Contact Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:

I/We the parents/guardian of the above child/children, hereby give my/our approval to his/her participation in the Summer Recreation activities. I/We assume all risks and hazards incidental to such participation including transportation to and from all activities.

I/We have indicated above if our child has any illness or limited ability which may require special attention during his or her participation in the program.

I Agree

By clicking the box you acknowledge that you have read and agree to the statements above.

Please be aware that payments will reflect on your statement as

CityFee 800-764-0844 Clinton UT


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