Player Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Physician Phone *

(###)

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Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Cell Number *

(###)

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Parent/Guardian Name #2

First Name

Last Name

Parent/Guardian Cell Number #2

(###)

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Consent and Liability Waiver I/We the parents/guardians of the above named person, who is trying out for a position on a JBC team, hereby give my/our approval for a duly appointed member of JBC to seek or administer emergency first aid or medical attention required for the safety or well being of my/our child while participating in any and all of the activities of the JBC program. I/we do further hereby release, absolve, indemnify and hold harmless the JBC league, the organizers, sponsors,the supervisors, the attending physician, hospital or medical group involved in the emergency attention of my/our child. *

First Name

Last Name

Both Player and Parent has read and understand the Juanita Girls Basketball Player Contract *

First Name

Last Name

I have read and understand the Concussion Awareness information provided by the AAU and JBC *

First Name

Last Name

Date *

MM

DD

YYYY