Winfield Youth Basketball League

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2020 HIGH School

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 #:

WAIVER INFORMATION

We promise to follow all safety guidelines regarding COVID 19 restrictions set forth by the WYBL and PCS. We will not hold WYBL or PCS responsible for any injury or illness contracted while participating in a voluntary volunteer run youth league.

I/we agree with the above *

* Jersey Size:

* indicates required fields

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2020 HIGH School