2025/2026 Bushnell Traveling Basketball Association

2025/2026 Bushnell Traveling Basketball Association

Registration Form
The Bushnell Traveling Basketball Association (BTBA) was organized exclusively for charitable, athletic, and educational purposes for the youth of our area. It was also organized to promote amateur athletic competitions among school age children.

Your coach will be contacting you to make arrangements to start practices during the month of October (late) and November.

This year, games will start in December and go thru February with some possible tournaments in March.

Once we have numbers for teams, we will be contacting you to come to a BTBA parent/player meeting, the player’s uniform will be handed out at a practice, and get general information about the league. Parents and players will also be required to sign a Player and Parent Agreement.

3rd - 5th Grade Practice/Games: Nov - Feb

6th Grade Practice/Games: Dec - Feb

REGISTRATION DUE: Monday, October 13

Participation Fee: $50 payable to BTBA

*Drop off payment at school office with slip provided. Check or Cash accepted.
Player's Name:*

First NameLast Name
MaleFemale
3rd4th5th6th
CONTACT INFO
Father's Name:

First NameLast Name
Father's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Name:

First NameLast Name
Same as Father's Address
Mother's Address:

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
PREFERRED CONTACT FOR SCHEDULE INFO
FatherMotherOther
Name*

First NameLast Name
Phone # preferred for text messages:*
Please enter a valid phone number.Format: (000) 000-0000.
Additional Name:

First NameLast Name
Additional Phone Number for text messages:
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACT INFO (used if parent is unavailable)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SHOOTING SHIRT

Player’s last name will appear on the back of the shirt. Shirts will not be reprinted for misspellings at BTBA cost.
Youth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXL
I, parent/guardian of the Player's Name mentioned above, give my permission for my child to participate in the 2025-2026 BTBA program. I hereby state that I have family health, accident, and hospitalization insurance which provides coverage for any injuries resulting from my child participating in any activities involving BTBA. I assume all responsibilities for any injury and/or expense in medical cost that could occur to my child while participating. I hereby release and fully discharge BTBA, its coaches, board members, and officers of any and all liabilities from any injury sustained by any child playing traveling basketball. I, the undersigned, have read this release and understand all of its terms. I have executed my signature voluntarily and with full knowledge of its significance.
By typing my name below, I understand and agree with the statement above and that this form of electronic signature has the same legal effect as a manual signature.*

First NameLast Name
Date:*

MonthDayYear
Date
Email for Parent/Guardian Completing the Form:*
example@example.com
Should be Empty: