BCWB
Fall Basketball League 2014
Mail-In
Registration Form
Print
out & Mail to BCWB, P. O. Box 3528, Fred. MD 21705
Boy
Girl
Team (Team must
submit roster ASAP)
Skill Set/Level Beginner
Intermediate
Advance
Player
First
and Last Name (If team - enter name as team name)
Player/Team
Age and Grade
Player
Address
City
State
Zip
Parent Email
Address
School
Home
Phone
Cell
Phone
Medical Problems?
Comments:
Have a players you like to play on the same team? Have a coach you
like to play on his/her Team?
T-shirt Size Youth
Small
Med
Large
XLarge
Adult Small
Med
Large
XLarge
XXLarge
No
Refunds after: August 1, 2014
Medical
Release & Registration Agreement
The
undersigned, parent/legal guardian of the player requesting league
admittance, does hereby affirm that the applicant is in good health and
suffers from no illness, disability, or condition that requires the
taking of medication on regular basis unless that condition is disclosed
and approved. Furthermore, the undersigned has no knowledge of any
reason the applicant cannot participate in vigorous physical activity.
The undersigned hereby expressly agrees to be responsible for any
medical bills incurred in the treatment of any illness or accident. In
the event of any such accident or injury, I hereby consent to allowing
any of the league supervisors to procure any medical treatment deemed
advisable on behalf of my child or ward without prior consent. I
understand that, as a condition of admittance as a league participant,
the undersigned, on behalf of all parents and guardians, and behalf of
the applicant, hereby release Basketball Coaches Without Boundaries and
all other employees or agents of the league from any and all liability
in regards to injury or illness, either mental or physical suffered by
the league participant during or related to the league by the person or
entity against which the claim is made.
Parent
Signature _____________________________________
Date:___________________
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