Byron-Bergen Central School District Athletic Department

JV and Varsity Wrestling Official Voucher 2022-2023

Name:______________________________________	Phone number: _________________________ (Please Print)

Address: ____________________________________________________________________________________ Number	Street	City	Zip code

Social Security #: _________-_________-_________ (Must be filled in, at least the first time to each district, to be processed)

Are You Employed by this district in any other capacity? Yes _______; No _______

Event:

Sport: Wrestling	Contest Date: _____________________________

Opponent: _______________________ Starting Time: __________ Game site: _________________

Varsity (fee)

JV (fee)

$108.00 $87.60

Extra bouts (Var.) _____ @ $7.20 = _____________

Extra bouts (JV)	_____ @ $5.85 = _____________

Note: Tournament fee is the same as extra bouts.
Total fee requested: = ____________

Signature: ___________________________________	Date:___________________

*Officials please note: By officiating this contest, and signing this voucher, you are indicating that you have been properly finger printed and background checked and that you have been found employable by NYSED standards in NYS Public Schools.

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Approved: _________________________________ Director of Athletics
Approved: _________________________________ District Office

Date: _______________

Date: _______________

Version: 1.0

df: 7/8/2021