Unified Sports Intent To Enter Form

Please complete all information below.
Multiple entries are encouraged, however all entries are "first come, first served", based on number of openings.
Submit a separate entry for each team/event you wish to enter.
If you are entering multiple teams in the same event be sure to use a unique team name for each.

Team Name:

School:

Telephone:

Address:

City/Town:

Zip Code:

Check the event you wish to enter:

Wed., Oct. 17 @New Canaan Country School 3:30-6pm (Entry deadline Oct. 4)
Sat., Nov. 17 @Jack Jackter Elementary, Colchester 10am-12pm (Entry deadline Oct. 21)

Approximate Total # of Students (athletes and partners):

Roster:

Name	Athlete/ Partner	Date of Birth

Name of Principal:

Name of Coach:

Coach's Cellphone:

Coach's e-mail:

CERTIFICATION

By checking this box the listed coach certifies that the students listed in the above form have satisfied the State Health Statutes and local regulations regarding physical examinations and are physically fit to participate.