Town of Collierville                          2002-2003 Youth Basketball
Parks, Recreation & Cultural Arts                            Player Registration Form
 

All players must be at least 7 or no older than 18 years of age on or before March 31, 2003
 

Did you play last season �    Yes      No                 $50.00
                                                                           ($20.00 late fee applies to registration beginning on Oct 7)

Player Name________________________________________________  Male_____  Female_______

Address____________________________________ City/State/Zip____________________________

Home Phone_____________________________ email_______________________________________

Player Age _________ (as of March 31, 2003)        Date of Birth     ______ /______ /______

Please size jersey as YS-youth small, YM-youth medium, YL-youth large, AS-adult small, AM-adult medium, AL-adult large, XL-adult extra large.  Jersey size is only to help in order for entire league.  Players may not receive exact size requested.  Players will receive acceptable jersey sizes.

*******If you do not know player�s height and weight, a measure tape and scales is available at front counter********

Jersey Size  _________           Player�s Height ______� ______�             Player�s Weight  ______ lbs

Father�s Name __________________________________    Day Phone _______________________

Mother�s Name__________________________________    Day Phone_______________________

Does your son or daughter play on an AAU, Jr. High, High School or Church team?            Yes                        No

If yes, your son or daughter is not eligible to participate in the Collierville Youth Basketball League.

We need volunteer assistance of parents to operate a quality program.  Would this parent be willing to help in the program as a volunteer?  (If interested in being a Head Coach, ask for a Collierville Athletics Coach/Official Form.  Fill out and turn in to be interviewed)

HEAD COACH        _________      ASSISTANT COACH        _________      OTHER          _________
 

I/We do further hereby release, absolve, indemnify and hold harmless the Town of Collierville, Collierville Parks, Recreation & Cultural Arts Department, the organizers, sponsors, supervisors, all employees thereof, and/or all of the above, incidental to the conduct of activities and transportation to and from such.  In case of injury, I likewise waive all claims against the organizers, sponsors, employees, or any instructors appointed by them.  I/We imply that all information given on this form is true and understand that suspension from Collierville Programs is possible if any information is false.

Signature of Parent/Guardian____________________________________   Date_______________

FOR STAFF USE ONLY, PLEASE DO NOT WRITE IN THIS BOX

FEE PAID $_______       (CASH/CHECK) DATE PAID ___/___/___    BIRTH CERTIFICATE VERIFICATION  _______

RECEIPT #  ________________                                  STAFF MEMBER TAKEN BY  ___________

For more information on any athletic activities, call 853-3225.