Woodland Beaver Boosters

Woodland Community Youth Basketball

Registration Form, Step 1 of 2

Player Name:	Grade:
Sex:	Age:
Address:	City, State, Zip:
Daytime Phone:	Evening Phone:
Parent/Gaurdian Names:	Emergency Contact:
E-mail:	Player T-shirt Size:	Youth Small; Youth Medium; Youth Large; Youth X Large; Adult Small; Adult Medium; Adult Large; Adult X Large;

Number of players:
One Child, $55.00; Two children $100.00; Three children $135.00

Note: If registering more than one child from your home, please submit this form once for each child, but only submit your payment one time.

Written Agreement:
My child has my permission to participate in this Woodland Youth Basketball program. I grant permission for emergency treatment to be given. I agree to pay all medical bills not covered by the insurance listed above. Insurance information must be complete or write NO COVERAGE in the space above. I release Woodland School District and the Woodland Beaver Boosters, their employees, volunteers, and assigns, from any liability resulting from injuries incurred during this activity.

Electronic signature (type name):