BMG Lakers Participation Form

BMG Lakers Program Registration Form

Tryouts Sunday 19th July 2026
Athlete Information
Player Name

First NameLast Name
DOB

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Registration Group
Guardian / Parents Names (If Under 18yo)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
Format: **********.
E-mail
example@example.com
Emergency Contact & Health Insurance Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: **********.
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?
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, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Agreements to participate in the BMG Lakers Program
I have read and agree to the above conditions
Confirmation E-mail
example@example.com
Signature
Should be Empty:

BMG Lakers Program Registration Form