Youth Basketball Registration Form
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1
2FOR LEAGUE USE ONLY
Registration #:
Registration Paid:
Yes
No
New Player
Yes
No
Candy Received
Yes
No
Rating #:
Moving Up
Yes
No
Total $ Received
Returning Player
Yes
No
Check Number
Would you like to be involved?
Interested in sponsoring a team?
Yes
No
Interested in coaching a team?
Yes
No
Eastlake Youth Basketball Registration Form
Last Name: _______________________________ First Name: _____________________ Phone: __________________
Address: __________________________________ City: ____________________ State: _____ Zip Code: ___________
E-mail Address: _______________________________ Parents Name: _______________________________________
Did you play on a middle school basketball team last year?
Yes
No
If yes, school name: ____________________
Do you have a brother or sister playing in this league?
Yes
No
Team name: _______________________________
Did you play last year?
Yes
No
Team name: __________________________________
Please check the division your child will be playing in: (League age is the age of the player as of August 31st)
Co-Ed
Boys
Girls
Division
Age
Division
Age
Division
Age
Hoopstar
5
ABA
8-9-10
GABA
8-9-10
CBA
6-7
NBA
11-12-13
GNBA
11-12-13
Birthdate:_____________ League Age: ________ Height in inches: __________ Shirt Size: YS YM YL AS AM AL AXL
Parents Statement:
“I hereby waive and relinquish any and all claims, demands and/or causes of action whatsoever against the city of Eastlake, and all personnel
associated with the organization, direction and supervision of the Eastlake Youth Basketball League. I also waive all claims, demands and/or causes
of action against any persons transporting the above named to any league activity.
In case of a recovery of a monetary judgment awarded to me as a result of participation in the Eastlake recreation program, it’s employees, agents,
and any and all personnel associated with the recreation program of the City of Eastlake, I hereby agree to reimburse the city of Eastlake, it’s
employees agents and any and all personnel associated with the recreation program of the City of Eastlake of any monetary award which may be
determined concerning claim as a result of participation in any Eastlake activity.
Please note: The Eastlake Recreation Department and the Youth Basketball League do not carry insurance on the participants or spectators in this
program. It is the sole responsibility of the individual to secure insurance if He/She so desires.
I also understand if scheduled league games cancelled due to the availability of gyms as so decreed by the Willoughby-Eastlake school system any
and all refunds will be prorated by the league officials and the Eastlake Recreation Department.”
I have read the above and understand what it is saying.
Signature of Parent/Guardian
Phone No.:
Date
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