Basketball Sign-Up Sheet 2017-2018


Register at either:
First Baptist Church of Gowensville
Age of youth as of 9-1-17
5650 Highway 14 North
Jersey size
Landrum, SC 29356
Highland Baptist Church
3270 Highway 414
Paid Registration Fee
Taylors, SC 29687
$30 per child--includes jersey * Must be of age by 9-1-17: Boys 5-12; Girls 5-14
Please complete this form and bring it with you to register.
Registration must be done in person and with the child present
during one of the following sign-up opportunities.
Thursday, 11-2-17, 6-8pm * Saturday, 11-4-17, 10-12noon * Monday, 11-6-17, 6-8pm
Late Sign-Up: Thursday, 11-9-17, 6-8 pm (extra $10 fee)
Participant’s Name:_____________________________Participant’s Age:____ Grade:____ Date of Birth:__________
Mother’s Name:___________________________Phone:_______________Email:_____________________________
Father’s Name:____________________________Phone:_______________Email:_____________________________
Emergency contact person in case parents cannot be reached:
Allergies or physical limitations of participant:
(In addition to writing the above information, please also share this personally with the participant’s coach.)
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 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, Highland Baptist
Church, and Ebenezer Welcome Baptist Church from any and all claims, demand actions, or cause of action, past, pre-
sent, or future, arising out of any injury to my said child.
Furthermore, I understand that practices and games will be at three different locations: FBC Gowensville, Highland
Baptist Church, and Ebenezer Welcome Baptist Church. I will make every effort to have my child at the majority of
practices and games. Practice starts in late November. The season begins in January and concludes in early March.
Parent or Guardian Signature:_____________________________________________Date:______________________


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