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Gwinnett Warriors Basketball Club Player Registration form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

PARENT/GUARDIAN

* Firstname:

* Lastname:

* Email:

Home Phone:

Work Phone:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

*** Insert your waiver information here ***

I/we agree with the above *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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