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Basketball League Registration Form

Collect everything a basketball league needs from new players before the season starts, including emergency contacts, insurance details, and signed acknowledgment of the rules.

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League Season

Player Name*

Nombre

Apellido

Are You Over 18?*

Yes No

Guardian/Parents Names*

Nombre

Apellido

Address*

Dirección

Ciudad

Estado / Provincia

Código postal

Home Phone*

Cell Phone

Email*

Basketball Skill Level*

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Interested in Volunteering While Your Team Isn't Playing?

Yes, I'm interested

I'd Like to Play on the Same Team as the Following Players (League Organizers Will Form Teams Based on This List and Your Skill Level)

Player's Date of Birth

T-Shirt Size

Emergency Contact's Name*

Nombre

Apellido

Relationship*

Phone Number*

Do You Have Health Insurance?

Yes No

Insurance Carrier

Name of Policy Holder

Subscriber ID/Group Number

Card Number / Card Date

Do You Have Any Allergies, Chronic Illness, or Medical Conditions That Would Limit High-Level Activity?*

Yes No

Please Describe*

Current Medications

Name of Physician / Emergency Medical Care Facility

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

Additional Notes

I Have Read and Agree to the Above Conditions*

I Agree I Do Not Agree

Confirmation Email*

Signature*

Sign here

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