Basketball League Registration Form

Youth Basketball League 2022- Registration Form (Child: 14 - 18, Adult 18+) Kennedy Memorial Park 335 Greenwich Street, Hempstead, NY nb193@gmail.com

Athlete Information

Player Name*

First NameLast Name

Are you over 18 ?*

YesNo

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Basketball skill level*

	1	2	3	4	5

1 is Beginner, 5 is Advanced

Interested in Volunteering while your team is not playing?

Match RefereeOperate Scoreboard

I would like to play on the same team with following players. League organizers will form teams based on this buddy list and your skill level.

Important Notes · Dress appropriately. The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.

Fee: $50 youth 14-18, $60 adult 18+.

Emergency Contact

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center facilities may cause injuries and/or death. 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 Youth Sport Center and the persons in charge.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form and pay via CashApp or Zelle. (below)

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 nb193@gmail.com