South Sac Basketball League

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Fall Season Player Registration Aug 28

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

* Grade:

* T-Shirt Size:

* Has your child played on a basketball team previously?:

* Preferred coach:

* Season:

WAIVER INFORMATION

All payments are non refundable.

South Sacramento basketball league is not responsible for bills pertaining to injuries that occur during participation.

I/we agree with the above *

*** Insert your waiver information here ***

Signature:

Date:

* indicates required fields

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

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Fall Season Player Registration Aug 28