3 on 3 Basketball Tournament
August 18th & 19th, 2018

Please check below and send the completed form and amount indicated to:  

Syracuse Select Basketball

6268 Hessler Farm Path Cicero, NY 13039
(315) 288-5119
(315) 224-1401

Male Division ___ 10 & Under *  ___ 11 & 12 * ___ 13 – 15 * ___ 16 – 18
____* Adult REC * ___ Adult Competitive         

Female ___ 10 & Under *  ___ 11 & 12 * ___ 13 – 15 * ___ 16 – 18
____* Adult REC * ___ Adult Competitive         

Note: A $120.00 Non Refundable deposit (including illness, injury, etc.) must accompany your application.  $135 after August 10th, 2018.  
Please Print Carefully!
Player #1 _______________________
ADDRESS_______________________________________  
CITY___________________________ STATE________  ZIP________________
PHONE (___) ____________________ EMAIL ADDRESS__________________

BIRTHDATE _____________________SCHOOL______________________________

Player #2 _______________________
ADDRESS_______________________________________  
CITY___________________________ STATE________  ZIP________________
PHONE (___) ____________________ EMAIL ADDRESS__________________

BIRTHDATE _____________________SCHOOL______________________________

Player #3 _______________________
ADDRESS_______________________________________  
CITY___________________________ STATE________  ZIP________________
PHONE (___) ____________________ EMAIL ADDRESS__________________

BIRTHDATE _____________________SCHOOL______________________________

Player #4 _______________________
ADDRESS_______________________________________  
CITY___________________________ STATE________  ZIP________________
PHONE (___) ____________________ EMAIL ADDRESS__________________

BIRTHDATE _____________________SCHOOL______________________________

HEALTH AND BEHAVIOR GUIDELINES:
I, the undersigned, submit my son is physically fit to participate in strenuous athletic activity and waive Syracuse Select, Inc. of any and all responsibility for injury or illness.  I hereby authorize the directors of Syracuse Select to 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 Syracuse Select with proof of medical and accident insurance.  I also understand that my payments are non refundable and non transferable under any circumstances.  I understand that anyone who does not abide by facility rules or regulations is subject to dismissal without refund or recourse:
SIGNATURE OF

PARENT/GUARDIAN ____________________________ DATE _______________