Name *

First Name

Last Name

Activity

Basketball

Cheerleading

Both

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Parent's Cell

(###)

###

####

I have read the waiver of liability and fully understand its terms, understand that I give up substantial rights by signing it, and sign it freely and voluntarily without any inducement. *

Agree

Disagree

Father/Guardian *

First Name

Last Name

Father's Phone *

(###)

###

####

I would like to assist this league by being a:

Coach

Referee

Team Parent

Mother/Guardian

First Name

Last Name

Mother's Phone

(###)

###

####

I would like to assist this league by being a:

Coach

Referee

Team Parent

Daytime Phone

(###)

###

####

Evening Phone

(###)

###

####