Basketball Coaches Without Boundaries

Player Name ____________________________________________ Height______ Weight_______

Address__________________________________City________________State_____Zip_________

Player's Home Phone:_______________ Player Email:__________________________________

Birthdate____________________ Age _______ Grade (2008 - 2009 School Year)_________

School Attending_______________________ Medical Problems?________________________

Parent/Guardian Name________________________________________ Work #________________

Parent / Guardian Address_____________________ T-Shirt Size XS S M L XL XXL
Phone __________________ Email___________________________________________________
How did you hear about us ____________________________(Radio,Gazette,Fred Post, Friend, TV)

(A) Personal Training $ 20.00 X (# Sessions ___) = Total _____________

(B) Fitness Session $15.00 X (# Sessions ___) = Total _____________

Total enclosed: $________________ (A + B )

Registration Instructions:

1) Fill out form completely and legibly.
2) Parent/Guardian must sign Medical Release, Code of Conduct and Parent/Guardian player permission.
No refunds after August 22, 2008. Mail Registration, Checks, or Money order to: BCWB,   P. O. Box 3528, Frederick, Md. 21705-3528.

Medical Release, Agreement to Abide by the Code of Conduct and Parent/Guardian player permission :
I certify that my child is in good physical condition and is fit to participate in Basketball Coaches Without Boundaries Fall Basketball League; I have read and understand the BCWB FBL Code of Conduct for players and spectators:   I agree, abide by, and promote the regulations and principles outlined in the Code. Additionally,    I understand that my participation in Basketball Coaches Without Boundaries activities involves risks and dangers of serious and permanent bodily injury. I, or my parent/guardian, if I am a minor, hereby release, hold harmless, discharge and agree not to sue Basketball Coaches Without Boundaries, its Directors, Officers, Employees, Coaches, Officials, Volunteers, Agents, Sponsors, Advertisers, Owners/Lessors of Premises for any and all liability from my participation in these and any other Basketball Coaches Without Boundaries related travel, lodging, social/recreational activities.
Date: ____________ Parent/Guardian Signature _________________________