Which session are you signing up for? *

Session 1 (7-9 year olds) 9:30am

Session 2 (10-12 year olds) 10:30am

Session 3 (13 & Up) 11:30am

Player Name *

First Name

Last Name

Player's Date Of Birth *

MM

DD

YYYY

Player's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Information *

First Name

Last Name

Parent/Guardian Cell Phone *

(###)

###

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Parent/Guardian Name #2 (optional)

First Name

Last Name

Parent/Guardian Cell Phone #2 (optional)

(###)

###

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Cell Phone *

(###)

###

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Medical Release *

This is to certify that I, the undersigned, have given permission for my child (named above) to play and take part in basketball. I realize there may be certain physical hazards connected with my child's participation in this activity and am willing to assume full responsibility. I hereby release the Voorhees Basketball Association, including its coaches, trainers, and administrators from any and all claims through the winter league season.