FLEETWOOD SUMMER BASKETBALL LEAGUE
REGISTRATION FORM
2009
PLAYER NAME ___________________________________________________
PHONE # ___________________________________________________
E-MAIL ADDRESS ___________________________________________________
SCHOOL DISTRICT ___________________________________________________
GRADE (as of September 2009) ________ DOB ________
AGE (as of September 2009) ________ HEIGHT ________
MEDICAL INSURANCE COMPANY __________________________________________
POLICY NUMBER __________________________________________
ADULT SHIRT SIZES CIRCLE ONE: SMALL MEDIUM LARGE EX-LARGE
Registration fee will be $35 dollars for Fleetwood Students and $40 Dollars
for all others. CHECKS SHOULD BE MADE PAYABLE TO SUE CONNOR.
Parent/Guardian Consent: I hereby give my consent for my child to participate
in FLEETWOOD SUMMER LEAGUE BASKETBALL LEAGUE. I also declare my child
to be in good health and give my permission for my child to receive medical and hospital
care as deemed necessary as judged by coach or representative of Fleetwood Summer
League.
SIGNATURE _____________________________________________________________
DATE ___________________________
SUMMER LEAGUE WILL PLAY April 1,2,3,4,6,7,8,9,11,13,14,15,16,17,20,21,22,23,26,27,28,29,30
MAY 1,2,3,4,5,6,7,8,11,12,13,14,15, 16,17,18,19,20,21,22,26,27,28,29 JUNE 1,2,3,4
POSSIBLE CONFLICT ACTIVITY ___________________________________________________
COACH OR LEADER'S NAME ___________________________________________________
PHONE OF ABOVE IF KNOWN ___________________________________________________
DATES OF CONFLICT WITH LEAGUE SCHEDULE IF KNOWN
___________________________________________________ Form please return to:
___________________________________________________ Sue Connor ___________________________________________________ 800 Golden Dr A-1 ___________________________________________________ Blandon, PA 19510
___________________________________________________ 610 944-1792 ___________________________________________________ ___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________