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Girls League Only Registration Form - Grades K - 8
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Address:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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2012
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2014
2015
2016
2017
2018
2019
2020
2021
*
Gender:
F
M
*
Grade:
K
1
2
3
4
5
6
7
8
*
School:
*
Shirt Size:
Y/S
Y/M
Y/L
A/S
A/M
A/L
A/XL
PARENT/GUARDIAN #1
*
Firstname:
*
Lastname:
*
Parent, Guardian Email:
*
Phone #:
PARENT/GUARDIAN #2 {Optional}*
Firstname:
Lastname:
Parent, Guardian E-mail:
Phone#:
*
Policy #:
*
Insurance Carrier:
WAIVER: I understand and accept the condition that neither Saints Girls Basketball, Mary Queen of Peace, facilities used, or anyone associated with this program assumes any responsibility for any accidents and/or medical, dental expenses incurred as a result of participation in this program. The applicant is in good health and able to participate fully with no restrictions. The applicant is covered by the insurance listed above.
I/we agree with the above
*
Fee: $150.00 per player/$250.00 for 2 players/$325.00 for 3 or more players. Please make checks payable to Mary Queen of Peace. Form & payment may be mailed/dropped off to: Steve Burgholzer, 13 Lewis St., Medford, Ma. 02155
FOR LEAGUE USE ONLY:
Instructional Division _______ Junior Division __________
Intermediate Division _________ Senior Division _________
Amount $_______________________
Check # _________ Cash _________
Sibling: _____________________________
* indicates required fields