Fremd Feeder Boys Basketball -- Registration Form

Fremd Feeder Registration 2011-12

Players Name:________________________________________________________

Parents name:________________________________________________________

Address________________________________City:___________Zip:___________

Home #______________________Cell#___________________Wk.#____________

Email:_______________________________________________________________

DOB:_________________________Age:______________Grade:________________

School:______________________________________________________________

Emergency Contact: Name___________________________Phone:________________

Any health concerns:_____________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Insurance Co:__________________________________________________________

Policy #:______________________________________________________________

Waiver Signature:_______________________________________________________
(must sign to participate)

Costs

        Player Fee installment #1 $475. due by 11/1/11

        Uniform Fee $ 75. due by 11/1/11

        Player Fee installment #2 $175. due by 1/14/12

Print and complete this form. Make check payable to:
Fremd Feeder Boys Basketball

Costs
Player Fee installment #1	$475. due by 11/1/11
Uniform Fee	$ 75. due by 11/1/11
Player Fee installment #2	$175. due by 1/14/12