Player Name______________________________________

Street___________________________________________

City___________________________Zip_______________

School________________________Grade______________

Birthdate______________________Age now___________

Height________________________Weight____________

Shirt Size (Circle one) YS YM YL AS AM AL AXL AXXL

Are you playing in any other league this season? __________

Did you play CBA last year? _____If so, team? __________

Parent/Guardian 1)_______________________Email________________________Phone____________

Parent/Guardian 2) 2)_______________________Email________________________Phone____________

EMERGENCY CONTACT_________________________________Phone______________

IT IS AGREED THAT ALL RISK WATCHING AND/OR PARTICIPATING IN CBA ACTIVITIES, INCLUDING, BUT NOT LIMITED TO BODILY INJURY, ARE ASSUMED BY PLAYER AND HIS/HER PARENTS AND/OR LEGAL GUARDIAN AS INDICATED BY THEIR SIGNATURE HERETO.

Parent/Guardian Signature___________________________________Date______________

Registration Amount Paid $________ CASH CHECK # _______ Rcvd. By _________

PRACTICES ARE HELD WEEKNIGHTS BETWEEN 6:00 AND 9:00 p.m. MUST BE AVAILABLE TO PRACTICE ONE OF TWO NIGHTS. IF YOU ARE UNABLE TO PRACTICE ON CERTAIN NIGHTS, CIRCLE THOSE NIGHTS BELOW.

Monday  / Tuesday / Wednesday / Thursday