Player's First Name
Player's Last Name
Date of Birth
Player's Prior Experience —Please choose an option—NoneSchoolHouse LeagueSteve Nash - BGCKLSummer CampRep
Gender —Please choose an option—MaleFemale
T-Shirt Size —Please choose an option—Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL
Medical Conditions
Player's Street Address
Player's City
Player's Postal Code
Parent/Guardian Name (First & Last)
Email Address please list the email address that you use regularly
Secondary Email Address
Cell Phone Number
Home Phone Number
Additional Emergency Contact Name (First & Last)
Relation
Additional Emergency Contact Cell Phone Number
Additional Emergency Contact Home Phone Number
Additional Children noyes
Additional Child #1 Full Name Additional Child #1 DOB Additional Child #1 Gender —Please choose an option—MaleFemale
Additional Child #1 T-Shirt Size —Please choose an option—Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL
Additional Child #1 Prior Experience —Please choose an option—NoneSchoolHouse LeagueSteve Nash - BGCKLSummer CampRep Additional Child #1 Medical Conditions
Additional Child #2 Full Name Additional Child #2 DOB Additional Child #2 Gender —Please choose an option—MaleFemale
Additional Child #2 T-Shirt Size —Please choose an option—Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL Additional Child #2 Prior Experience —Please choose an option—NoneSchoolHouse LeagueSteve Nash - BGCKLSummer CampRep Additional Child #2 Medical Conditions
Limited Liability Policy: Liability of the LWBA and/or any of its officials, affiliates, sponsors, or executive members, does not extend to any form of injury, damage or loss resulting from any accident, from known or unknown conditions, handicap, or infection caused while participating in or traveling to or from any LWBA activity.
Photographic Image Policy: Photographic images taken of LWBA houseleague players during practices or in the promotion of the LWBA, may be used at the sole discretion of the LWBA, along with the use of the player's name.
Refund Policy: Refunds will be considered on an exception basis and may be granted at the sole discretion of the LWBA.
Parent / Guardian Acknowledgement: I hereby acknowledge that I have read the above disclosures and my signature indicates my agreement and consent with these terms.
Parent/Guardian Name Signature Type name again
Other Information or Comments
Any registrations received once the spaces are filled for each age group, will be placed on a waitlist. If payment is not received with registration, your child's name will be added to the waitlist.