Print,
Complete and Mail to BCWB, P. O. Box 3528, Frederick, Md. 21705
| Player |
One |
Two |
Three + |
| Regular Rate |
115.00 |
100.00
(Each) |
95.00
(Each) |
|
| One |
Two |
Three + |
| 105.00 |
100.00
(Each) |
95.00
(Each) |
|
| One |
Two |
Three + |
| 215.00 |
190.00
(Each) |
180.00
(Each) |
|
|
First
& Last Name
Boys League
Home
Address
Girls League
City,
State and Zip
Home
Phone
Cell Phone
Email
Address
School
Grade
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
T-Shirt
Size Adult Small
Med
Large X-Large
XX-Large Youth
Small Med
Large
X-Large
(Please
select one)
Have
you ever played in any BCWB Basketball Program
Summer
League Fall
League TJMS
Mid-Maryland Team
AAU
Would
you like to volunteer? Name:
Email:
Head Coach
Elementary/Middle
School High
School
Assistant Coach Elementary/Middle
School High
School
Concessions
Scorekeeper
Timekeeper
Special
Request (coach, team, on same team with another player, etc.)
No
Refunds after: February 15th (Spring
Basketball League) April 15th (Summer
Basketball League)
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 ______________________