Eastern Basketball Fall 2008 Individual Basketball Sign Up Form

• Parent 1 / Guardian Contact Information

  *First Name
  *Last Name
  *Street Address
  *City
  *State
  *Zip Code
  *Home Phone
  Work Phone
  Cell Phone
  *Main E-mail
  2nd E-mail address to send updates to:

  Player Name

  *First Name
  *Last Name
  *Grade Registering	Please choose.. 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade HS Junior Varsity HS Varsity
  *Level	Please choose.. HS Varsity Level JV Level AAU Level Travel A Level Travel B Level
  *Sex	Male Female
  *Jersey Size	Select.. Adult Small Adult Medium Adult Large Adult XL Adult XXL Youth Large
  *Total Dues	Select $145

  Please add Emergency contact even if it's the same as above.

  Emergency Contact(s):
  Emergency Phone(s):

  Please add any comments, FRIENDS or TEAMMATES signing up, preferred town you want to play on if applicable, special instructions, other phone numbers or other information that may be important to us!

   

  I agree that I am authorized to fill out this form and register the above individual for the Eastern Basketball Fall 2008 League. I hereby represent the registered person and all parties, players, coaches, parents, guardians and representatives agree to hold harmless any and all persons involved in the Eastern Basketball Program, DELCI, Eastern Travel League, Cape Ann Travel League, Eastern Basketball, Doug Lindland, and any employees, contractors, sub-contractors, officials, referees, board members and Gordon College/Sterling YMCA employees, agents, contractors, sub contractors and agents for any injuries, accidents, cancellations and other unforeseen events and circumstances. 

  Please type your name agreeing to above statement:

  * Confirm:                                  Please type CONFIRM in the box

  Be sure all information is accurate before submitting the form. When you press Submit, an automatic form will be generated for you. Please print, sign and mail it in with your check or pay online here. By registering here, your information is automatically entered into our database - thank you!
   

• Be sure all information is accurate before submitting the form. When you press Submit, a form confirmation will appear on your screen. Thank you!
   
• PLEASE ONLY SUBMIT THIS FORM ONCE - IT MAY TAKE UP TO 60 SECONDS TO SEE THE CONFIRMATION
• There are no refunds once the Fall league starts.