Backcourt Hoops at Riverfront Sports Complex 5 West Olive Plaza Scranton PA 18508 570-558-3833 Fax 570- 558-3835 John Bucci JBucci@backcourthoops.com Jeff Fedak Jeff@backcourthoops.com Ted Zwiebel tzwiebel@backcourthoops.com
League Fee: $ Team Name: Team Street Address: City: US State: Zip:
GRADE : Coach's Name: Coach's Email: (required) Coach's Telephone: (required) with area code Coach's Cell Phone: (required) with area code
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Player's Name Email Phone Number
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Additional players can be added via email My players are 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 Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that each players parents are solely responsible for the payment of any such medical expenses. I also understand that my payments are non-refundable, non-transferable under any circumstances. By Pressing the submit button you agree to the above.
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PAYMENT: After you click the Submit Registration button, you will be taken to a screen where you can send payment via safe, secure PayPal! You will also see information on how to pay by check instead. No refunds if a team cancels
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