Mpls Lady Lakers Basketball Club

4439 Hiawatha Ave So., Minneapolis, MN 55406 - Office: 612-721-1111 Cell: 612-559-0001

PLAYER REGISTRATION FORM

PARENTS AND PLAYERS, please read and indicate your agreement by signing below:

I hereby approve my child’s participation in the Mpls Lady Lakers tryouts and consent to emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions, which will interfere with my child’s participation. The Mpls Lady Lakers and the Midtown YWCA, as well as any other location we play our activities in, will assume no liability for injury or damage arising from the results of participation. Basketball presents certain inherit risks and hazards, which the participant and his/her parent or legal guardian is/are urged to consider, and which the participant assumes.

PLEASE FILL IN ALL BOXES-YOUR FORM WILL NOT BE RECEIVED IF YOU DON'T!

ATHLETE'S NAME I AGREE TO THE ABOVE WAVER

PARENT'S NAME I AGREE TO THE ABOVE WAVER

PLAYER'S BIRTH DATE: MONTH DAY YEAR

HOME ADDRESS

CITY STATE ZIP CODE

ALL 6 NUMBERS ARE REQUIRED. INCLUDE AREA CODE. REPEAT NUMBERS IF YOU MUST.

HOME # MOM'S WORK # DAD'S WORK #

PLAYER'S CELL # MOM'S CELL # DAD'S CELL #

PLAYER'S E-MAIL ADDRESS

SCHOOL ATTENDED IN 2007-2008

GRADE COMPLETED 2007-2008

PLAYER IS IN CLASS OF

2007-2008 WINTER TEAM NAME

2007 AAU TEAM POSITION HEIGHT

T-SHIRT SIZE

HOW DID YOU FIND OUT ABOUT THE MPLS. LADY LAKERS?

HOW DID YOU FIND OUT ABOUT THIS TRYOUT?

Copyright © 2008 MPLS. LADY LAKERS. All rights reserved. Revised: 02/02/08.

Copyright © 2008 MPLS. LADY LAKERS. All rights reserved.
Revised: 02/02/08.