Players Name:     Street:  
City: State:     Zip: Phone:
cell:      Shirt Size: Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Extra Large Adult XXL   Age:   Grade:   
Birth Date:     E-Mail   School:

Girls  League  Starting Saturday Nov 8th
    Grades K thru 1st         Grades 2 thru 3rd
    Grades 4-5                   Grade 6-8th            
I would be willing to Sponsor a team    $100 per team  Your name or company on team Shirt
 enter Sponsor name

Yes I would Like to Help Coach
Head Coach  Please enter your name
Asst.  Coach  Please enter your name

Total Amount for registering   Cost $45     2nd child same Family $40   3rd $35

Health Insurance Co.      Group #: Policy #:
My child is in excellent physical health and capable of participating in strenuous physical activity, and waive Backcourt Hoops of any and all responsibilities for injury or illness. I hereby authorize the director of Backcourt Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that I am solely responsible for the payment of any such medical expenses and must provide Backcourt Hoops with proof of insurance. I also understand that my payments are non-refundable, non-transferable under any circumstances.
Signature of Parent/Guardian By typing your name  you are giving an electronic signature Date:

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Allow 30 seconds after pressing submit. Please Know your total amount before  Pressing submit. this page does not give you a total