Basketball Sign-Up Sheet printable pdf download

Age of youth as of Sept. 1st, 2016

First Baptist Church of Gowensville

Jersey Size:_______________________

5650 N. Hwy 14, Landrum SC 29356

Division__________________________

Paid Registration Fee_________________

(864) 468-4408

Basketball Sign-up Sheet

Please complete this information and bring it with you to the sign-up dates. Registration must be done in person on one

of the following sign-up dates.

Sign-up Dates & fee $30 per youth: November 3rd - 6-8pm, Sat. November 5th - 10-12noon,

Mon. November 7th - 6-8pm, Late Sign-Up - Thurs. November 10th - 6-8 pm (extra $10 fee)

Name:___________________________________ Youth’s Age______ Grade:_____ Date of Birth___________

Address:___________________________________________________________________________________

City:______________________________ Zip:__________ School you attend:___________________________

Youth’s Cell Phone #_________________________

Email address:______________________________

Mother’s name:_________________________________________ Phone #:_____________________________

Father’s name: _________________________________________ Phone #_____________________________

Please list an Emergency Contact in the case that you were not able to be reached.

Additional Contact Name:____________________________ Phone:__________________________________

Any Allergies of Physical Condition:____________________________________________________________

__________________________________________________________________________________________

In addition to writing this information here, please personally tell a coach of any information listed above.

Are you affiliated with a church in our area?_____ Name of church:____________________________

I, the undersigned, do hereby consent to authorize the directors of the LifeSprings Basketball League (FBC Gowensville) to

obtain for my child such medical care, treatment, and hospitalization as they deem necessary. I, the undersigned, do hereby

release, remiss, and forever discharge the directors, coaches, staff, and First Baptist Church of Gowensville from any and all

claims, demand actions, or cause of action, past, present, or future, arising out of any injury to my said child.

Parent or Guardian Signature: ___________________________________________Date:________________________

Basketball Sign-Up Sheet