<Font Color=blue>STNY Flyers</font> - (Endwell, NY)

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PLAYER INFORMATION

I am the legal guardian or parent of the player that I am signing up *

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Age as of January 1st , 2018:

AAU Membership #:

* Birthdate-Please note: Player can be no older than 18 on 1/1/18:

* Preferred # for Uniform (list up to 3) ie.. 10/4/14:

No guarantee that we will be able satisfy the uniform number

* Gender:

* Grade:

Height ft / in:

List positions played. (Guard,point,Center,Forward):

* Highest Level of play ? / Flyers ?:

* School that you attend:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* E-mail:

* Home Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

List all Player pre-existing medical conditions:

List other commitments / conflicts:

* indicates required fields

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

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