2015 Wpsl Player Registration Form printable pdf download

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

Date

Mail this form and your registration fee to:

Jeremy Eggers, 14150 NE 20

St F1-95, Bellevue, WA 98007

2015 Wpsl Player Registration Form