Basketball League Registration Form

Lake Wales Youth Basketball & Cheer Season 5 - Registration Form

(age 5-15)

LWyouthbasketball@gmail.com

Athlete Information

Player Name

First NameLast Name

Age

DOB

Date

Uniform Size

Shirt SizeShorts Size

School

Guardian / Parents Names

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Primary Parent Cell Phone

Area CodePhone Number

Secondary Parent Cell Phone

Area CodePhone Number

Primary E-mail

Basketball skill level

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering while your team not playing?

Emergency Contact & Health Insurance Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions that would limit high level activtiy?

Please describe

Release of Liability Although the safety of all sport activities is the primary concern of the Lake Wales Youth Basketball League, there is risk of injuries and/or death with any physical activity. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Lake Wales Youth Basketball league and its agents and leadership

I have read and agree to the above conditions

Confirmation E-mail

Signature

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at LWyouthbasketball@gmail.com

Important Notes ·Dress appropriately. · No food or drink in the gym. ·Keep the gym clean. The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced. ·

Fee: $120 Basketball, $150 Cheer (cash/cashapp/credit/debit) per participant. All the money will be used for uniforms and league operation such as insurance,referees, concessions, gym usage and equipment.

My Products

Season 5 Basketball Registration$120.00

Multiple Children Registration

Season 5 Cheer registration$150.00

Online Payment Form Processing Fee $5.25

To avoid this fee, pay in cash or by cashapp $lwyouthbasketball

Enter coupon

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.