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VALDOSTA CITY LAKERCATS 2024 REGISTRATION FORM (12u/6th-9u/3rd))BOYS AND GIRLS

* 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 #:

WAIVER INFORMATION

THE VALDOSTA CITY LAKERCATS STAFF WOULD LIKE TO THANK YOU FOR ALLOWING US TO EXPOSE YOUR CHILD TO AN EXCITING AND COMPETITIVE BASKETBALL EXPERIENCE. WE LOOK FORWARD TO DEVELOPING PLAYERS FOR THE NEXT LEVEL AND BEYOND.

THE VALDOSTA CITY LAKERCATS STAFF
THE VALDOSTA CITY LAKERCATS ARE A NON-PROFIT 501c3 ORGANIZATION

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Valdosta City LakerCats Registration Fee($264) *