Clone of 25-26 Biddy Basketball Registration

Athlete Information
Player Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Age of Player on 3/1/26*
Age
Gender*

MaleFemale
Players Shirt Size*
Primary Contact & Health Insurance Information
Primary Contact's Name*

First NameLast Name
Relationship*
Primary Contacts Number*

Area CodePhone Number
Primary Contacts E-mail*
Does the player have health insurance ?*

YesNo
Insurance Carrier
Coaching Opportunity

If you would like to volunteer to coach, send an email to jkinchen@townoflivingston.com with your information and select from below.
I would like to coach!

Head CoachAssistant Coach
Head Coach's Name

First NameLast Name
Head Coach's Number

Area CodePhone Number
Head Coach's E-mail

Confirmation Email
Head Coach's Shirt Size
Assistant Coach's Name

First NameLast Name
Assistant Coach's Number

Area CodePhone Number
Assistant Coach's E-mail

Confirmation Email
Assistant Coach's Shirt Size
Disclaimer

I, the undersigned legal guardian of the above named player, do recognize this as a voluntary extra curricular activity. Furthermore, I assume full responsibility for my child both during practice and during games. My child is covered by the above named medical insurance.
Signature*
My Products
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Registration Fee$100.00

Total $0.00
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