Basketball League Participation Waiver

Basketball League Participation Waiver
Complete this form to participate in the basketball league. Your information will be used for registration, emergency contact, and waiver acknowledgment.
Full Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any allergies or medical conditions we should be aware of?
If yes, please specify your allergies or medical conditions
Basketball Experience Level
Participant Signature
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