Basketball League Registration Form
League will be on Saturdays beginning January 6th-February 10th.
Date Today
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Month
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Day
Year
Date
Player/Child 1 Information:
Player 1 Name
*
First Name
Last Name
Player 1 Date of Birth
*
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Year
Player 1 Group (Determined by Fall 2022 Class)
*
T-Shirt Size
Adult Medium
Adult Small
Youth Large
Youth Medium
Youth Small
Player/Child 2 Information (if applicable):
Player 2 Name
First Name
Last Name
Player 2 Date of Birth
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February
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1920
Year
Player 2 Group (Determined by Fall 2022 Class)
T-Shirt Size
Adult Medium
Adult Small
Youth Large
Youth Medium
Youth Small
Player/Child 3 Information (if applicable):
Player 3 Name
First Name
Last Name
Player 3 Date of Birth
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
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Day
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2022
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2019
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2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Player 3 Group (Determined by Fall 2022 Class)
T-Shirt Size
Adult Medium
Adult Small
Youth Large
Youth Medium
Youth Small
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Next
Emergency Contact Information
Name of Emergency Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Relation to Athlete
*
Back
Next
Checkout Selection-Price includes a T-shirt and Basketball for Kindergarten Players and first time participants
*
prev
next
( X )
Number of Registered Players
$
20.00
Select if registering 1 player/child.
Quantity
1
2
3
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Parental/Guardian Consent
Waiver
I am fully aware that this sport activity may cause accidental injury to athletes. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against the Commission and the Organizing Committee of this event should in any case that the accident, injury, illness or death occurs in the course of any activity held by them.
Name
*
First Name
Last Name
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: