Peru State College
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Intramural Team Entry Form

Team Name:
Team Captain:
Team Captain's Phone #:
Official Roster:
01. 02.
03. 04.
05. 06.
07. 08.
09. 10.
11. 12.
13. 14.
15. 16.


Please list all days and times your team cannot play. You can find the start date of each sport on the Intramural Event Calendar. Games will be scheduled on Monday - Thursday evenings. The Intramural Office will try to schedule around times noted if possible. In case of inclement weather, please stop by the Intramural Office, located in the Student Center, or contact Student Activities Coordinator, Chelsea Allgood at 402.872.2252 or Jeremy Esry at 402.872.2441.


e.g. Monday: 7:00 - 9:00

e.g. Tuesday: 6:00 - 7:00

Team Entry Confirmation

Any registrations submitted after 5:00pm on the designated due date will not be accepted. Due dates can be found on the Intramurals Event Calendar. Any questions or comments please contact Kristiaan Rawlings at 402.872.2246 or Jeremy Esry at 402.872.2441.


The team captain is the contact person for the entire team. He/she is responsible for verifying the eligibility of the team, and notifying them of games, cancellations and the rules of the sport in which they are participating in. By typing your name and date in the boxes below you certify that the above information is correct to the best of your knowledge.

Team Captain:
Date: e.g. 01-01-10

Type the characters you see in the picture below:

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