PLAYER REGISTRATION Basketball League Registration FormAthlete InformationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Player's Name *FirstLastGender *MaleMaleFemaleOtherAre you over 18? *YesNoGuardian / Parent Name *FirstLastAddress *Postal Code *City *Home Phone *Cell PhoneEmail *EmailConfirm EmailBasketball Skill Level *12345Beginner to Advanced Interested in Volunteering while your team not playing?Match RefereeOperate ScoreboardI would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.Emergency Contact Name *FirstLastRelationship *Please SelectMotherFatherGrandparentUncleAuntSiblingBaby Sitter/NannyOtherPhone Number *Do you have health insurance ?YesNo, I'll pay with cash.If Yes, Insurance CarrierName of Policy HolderSubscriber ID / Group NumberCard Number / Card DateDo you have any allergies, chronic illness, or medical conditions that would limit high level of activity? *YesNoIf Yes, Please DescribeName of Physician / Emergency Medical Care FacilityParental 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.I have read and agree to the conditions below *YesNoRelease of Liability. Although the safety of all sports activities is the primary concern, indoor sports activities at Sports 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 agree to the following charge: *Registration Fee - $ 75.00Total$ 0.00Credit Card *Submit
