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Girls 4-5th (8.5 ft
Baskets), 5-6th grade & 7-8th
Girls Winter team League Registration 2010
9 Games Guaranteed 8 Game season everyone makes playoffs $320 starts Monday Nov 29th
Games are on Monday night thru Feb. All Games
Stop Clock
each team must supply a scorekeeper or clock operator
Please Print:
Age Group _____ 4-5th ____
5-6th Grade ____ 7-8th Grade
Team Name: ____________________________ Coaches Name_______________________________________
Street: _________________________________
City:
_______________________ State: ____ Zip: ______
Phone: ___________________ Cell Phone ________________________
Fax: ____________________
E-Mail
_________________________________
Payment Information: Amount Charged: $ ____________
Card #: ____________________________________
Name on Card: ____________________ Exp: __________
Cardholder Signature: ___________________
y 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 Hoopsto 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 _________________________________________
Date: _____________
Mail or Fax to:
Backcourt Hoops
5 West Olive Plaza Scranton PA 18508
Office use only:
Amt pd. _________ Date Rec. ___________
Balance: ______________
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