Point Lonsdale Basketball Club

Point Lonsdale Basketball Association

Player Registration

#WEBSITE

Player Information

Player Name*

First NameLast Name

Player's Year of Birth *

YYYY

School Player Attends

Guardian / Parent's Name*

First NameLast Name

Mobile Phone *

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

E-mail*

Basketball skill level*

	1	2	3	4	5

1 is Beginner, 5 is Advanced

I would like to play on the same team with the following players. Team organizers will try to form teams based on this buddy list, age groups and a balance of player skills.

Important Notes

· Uniform and dress code:

- Each player will be provided with a team singlet. Players must provide their own black shorts with no pockets. Singlet and pocketless shorts must be worn to all matches.

- For player safety, players cannot wear any jewellery at training or matches. If earrings are left in they must be taped over. Hair must be tied back.

(#Link to BPBA code conduct)

Emergency Contact Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Mobile Phone *

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

YesNo

Please describe*

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child. I give consent to secure any and all necessary emergency medical care for my child.

Name of Doctor / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

Although the safety of all sport activities is the primary concern, sport activities 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 Point Lonsdale Basketball Association 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. 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 #email address.