Player: Baltimore Cougars Legends D. League Tryout Application

Baltimore Cougars Legends

Development League Competitive Tryout

Application

Women’s Blue-Chip Basketball League, LLC

www.BmoreCL.com

BaltimoreCougars@gmail.com

Date: April 14, 2018 $40 until 4/12

April 28, 2018 $45 at door 4/18

Where: Coopermine Field Areana

*Make Payment @ Pay.BmoreCL.com
Try-out Fee

$40 Unitl 4/12$45 at Door & through 4/18
Athlete Information
Player Name*

First NameLast Name
Gender

FemaleMale
Are you over 18 ?*

YesNo
DOB

MonthDayYear
SSN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
Basketball level*

NJCAANCAA D1NCAA D2NCAA D3OverseasOther
College*
Position

Point GuardShooting GuardSmall ForwardPower ForwardCenter
Point avg., Steals avg, Reb avg., FT avg, etc..*
Basketball Accolades: *
(optional) Insert College website link with stats or game news
Upload Player Resume

Upload a File

Cancelof
Important Notes

· Dress appropriately.

· No food or drink in the gym.

· Keep the gym clean.

· The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Do you have health insurance ?

YesNo, I'll pay with cash.
Insurance Carrier
Name of Policy Holder
Subscriver ID/Group Number
Card Number / Card Date
Do you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe*
Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel and I authorize the person in charge to:
I give consent for the facility to secure any and all necessary emergency medical care.
Name of Physician / 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, indoor sport activities at Sport Center's facilities 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 Sport Center 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 baltimorecougars@gmail.com.
Should be Empty:

Release of Liability