Player Registration - The Jr ABA

Form

Participants' Name

Age

Address

Street Address

City

Country

Date of Birth

MM/DD/YYYY

Parent/Legal Guardian Name

Home Phone

Cell Phone

Work Phone

Emergency Contact #1

Name, Address, Phone Number(s)

Emergency Contact #2

Name, Address, Phone Number(s)

Participant's Allergies

Participant's Medical Conditions

Participant's Physician & Phone Number

Name and Phone Number

Signature

Waiver of Liability Release Clause

I am aware of the nature of this activity, and I hereby assume responsibility for the participant to participate and to be photographed for publicity purposes. I will not hold the JR. ABA and/or it's employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of the JR. ABA to participate in this program.

Registration

Price$90.00

Buy

Quantity

$90 (includes uniform)

Payment

Discount

Subtotal

Tax

Total USD