Girls Basketball Association Registration Form

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EAST HANOVER GIRLS BASKETBALL ASSOCIATION
E-MAIL: _________________________________________
____________________________
__________________________
Player’s Name
Telephone
Address: _________________________________ Date of Birth ____________ Grade _____
Father’s Name: ____________________________ Work/Cell phone: ___________________
Mother’s Name: ____________________________ Work/Cell phone: ___________________
Emergency Contact: _________________________
Telephone #: ______________________
Medical Ins.Name & Policy # _____________________________________________________
KNOWN ALLERGIES OR PERTINENT MEDICAL INFORMATION (PLEASE DESCRIBE):
____________________________________________________________________________
__
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Uniform Sizes (circle sizes:
Shirt Size: Youth SM MD LG
Adult
SM MD LG XL XXL
Short Size: Youth SM MD LG
Adult
SM MD LG XL XXL
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Coach’s Shirt Size (cir cle)
VOLUNTEERS: Head Coach: _______________________________ AL AXL AXXL
Ass’t Coach _______________________________ AL AXL AXXL
SPONSOR
_______________________________ $300 FEE PER TEAM
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Please write any activities including date and time that you anticipate your child taking Nov.-Mar.
____________________________________________________________________________________
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REGISTRATION FEE (please make checks payable to: East Hanover Girls Basketball Assoc.
Division Fees:
1st & 2nd grade clinic
$75
Division Fee
_________________
3rd - 8th grades
$95
Discounted fee (
_________________
2nd , 3rd child, etc.)
Total Registration Fee
_________________
Family Discount - First Child is at full price. All other children in family receive $10 discount.
Cash ________________
Check # ________________
******************************************************************************
Consent: I hereby give my daughter permission to participate in all activities sponsored by the East
Hanover Girls Basketball Association for the upcoming season. I, furthermore, agree to hold harmless the
East Hanover Girls Basketball Association and the Township of East Hanover for any physical harm that
might be incurred during the course of the season. My daughter has been recently examined by her
physician and is cleared to play in this activity. I understand that my daughter is required to be covered
by primary medical insurance in order to participate in this program, and by signing below, I agree to the
concent and I confirm that she is covered by a primary medical insurance policy. I will notify you if she
no longer has this coverage.
Signature of Parent/Guardian: _____________________________ Date:__________________
PLEASE TURN OVER

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