Name Birthdate Grade

         Last Name, First Name

Address, City, Zip Phone Number

Years Experience Height Weight School

Parent e-mail address

Parent's Names (Father/Mother) Cell Phone

Is the child covered by a family health insurance plan? Yes No

Physicians Name Phone

Emergency Contact (other than parent) Phone

If you aware of any medical condition affecting your child's well-being playing basketball, please state it here. If none, state NONE.

To enable the league to keep the registration fee as affordable as possible you will required to help out periodically duringthe season as a timekeeper,
scorekeeper,gym clean-up,etc.Thank you for you cooperation.

I herby agree to the terms above and give my permission for the said child to play in the Center Grove Girls Basketball League.

Parent's name Date

Would you consider being nominated to join the board of directors? Yes No More Info

Would you like to help in the following areas? Coach Assistant Coach League Sponsor

Photo package included in registration fee.Red/white reversible jersey will be provided for girls in 3rd through 8th grade.T- shirts will be provided for girls in K,1st and 2nd grade.Name requested on shirt

Please indicate shirt size: YS YM YL AS AM AL AXL

Shorts available for purchase,indicate size if purchasing shorts: YS YM YL AS AM AL AXL

 

Basketball league use only:

Paid by Check # Cash

Board member initials