2015 Wpsl Player Registration Form


2015 WPSL Player Registration Form
Cost: $125 (payable to: Premier Basketball)
please print or type clearly
Player’s Name: ____________________________ Team Name:____________________
Address: ___________________________________________ City: ________________
Home Phone: ___________________________ Cell Phone: _______________________
School: __________________ Height: _______ Weight: ________ Class of: __________
Email: __________________________________________________________________
Liability of Release:
All participants must have accidental medical insurance while participating in our traveling directly to and
from the Premier Spring Basketball League.
Parents Name(s): __________________________________________________________
Home Phone: ______________________________ Cell Phone: ____________________
Accident Insurance Waiver:
I accept full responsibility for any injury my son may suffer while taking part in the Premier Spring
Basketball League.
My insurance plan: ________________________________________________________
Company Name: __________________________________________________________
Policy #: ________________________________________________________________
Provides full coverage and releases the Premier Spring Basketball League and all other sponsors and their
employees of any financial responsibility.
In the event of injury my son should be referred to:
Doctor’s Name: __________________________________________________________
Phone #: ________________________________________________________________
My insurance policy will assume full responsibility for any medical expenses.
Parent/Guardian signature
Mail this form and your registration fee to:
Jeremy Eggers, 14150 NE 20
St F1-95, Bellevue, WA 98007


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