Unified Sports Roster Form

Please complete all information below. Submit this form once for each squad you will be entering (roster limit is 15 per squad):

School:

Squad Name:

Skill Level:

5 -- Severely limited, small baskets challenge medals
4 -- Low level, no partner shooting or rebounding, challenge medals
3 -- No partner shooting, competitive medals
2 -- Some modifications
1 -- Skilled

Check event you wish to enter (submit an entry for each event):

Mon., Jan. 30-New Haven Athletic Center-SCC League ONLY 3-5:30pm
Mon., Feb. 27-St. Lukes New Canaan-High Schools & Middle Schools 3:30-6pm
Fri., Mar. 2-Windsor HS CCC League Level 2 Teams ONLY 3-5:30pm
Mon., Mar. 5 -- Wilcox Tech HS, Meriden-Middle Schools 3-6pm
Mon., Mar. 5-East Haven HS-Middle Schools 3-6pm
Tues., Mar. 6- Tolland HS-High Schools 3-6pm
Tues., Mar. 6- Fairfield Ludlow HS-High Schools FCIAC league 3-6pm
Wed., Mar. 7-Simsbury HS-High Schools 3-6pm
Thurs., Mar. 8-Bunnell HS, Stratford-High Schools SCC League 3-6pm
Fri., Mar. 9-Farmington HS-Middle Schools 3-6pm
Fri., Mar. 9-Haddam Killingworth Middle School-Middle Schools 3-6pm
Mon., Mar. 12- Norwich Free Academy-High Schools and ECC League 3-6pm
Tues., Mar. 13-Glastonbury HS-High Schools 3-6pm
Wed., Mar. 14-Berlin HS-High Schools and CCC League 3-6pm
Fri., Mar. 16-Manchester HS-High Schools and CCC League 3-6pm
Tues., Mar. 20-New Haven Field house-Middle Schools 3-6pm
Thurs., Mar. 28-Bristol Central HS (LEVEL 5 ONLY) Middle or High Schools 3-6pm
Thurs., Mar. 29-Wilby HS-High Schools 3-6pm

Name	Date of Birth	M/F	Unif. Num.	Athlete/ Partner

Name of Coach:

Coach's Home Telephone:

Coach's e-mail:

CERTIFICATION
By checking this box the listed coach certifies that he students listed in the above Unified Sports Roster Form have satisfied the State Health Statutes and local regulations regarding physical examinations and are physically fit to participate in the tournament.