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2019 Friday Night Hoops
This form MUST be completed by a parent/guardian of participant if 17 years old or younger. Participation is only allowed once this form AND payment have been received. Each spot in this league will remain open until at least FOUR team members have completed this form.

Please contact Jon Reimer at jreimer@superioryma.org if you have any questions.

LAST NAME *
Your answer
FIRST NAME *
Your answer
Player's phone number *
Your answer
Player's email address (MUST BE ACTIVE) *
Your answer
Team Name *
Your answer
Who are your teammates? (4-player minimum, 10-player max) *
Your answer
CURRENT GRADE IN SCHOOL *
What school are you attending?
Your answer
Parent(s) Name(s) *
Your answer
Parent(s) Email (MUST BE ACTIVE) *
Your answer
MAILING ADDRESS *
Your answer
PARENT'S PHONE NUMBER *
Your answer
PARTICIPANT'S jersey size *
Name of your team's ADULT coach/supervisor *
Your answer
Coach's email address (MUST be active) *
Your answer
Coach's phone number (MUST be active) *
Your answer
(MUST BE READ BY PARENT/GUARDIAN) I hereby give my permission and approval for the above-named student to participate in the 2019 Friday Night 4-on-4 Hoops season. I assume all risks and hazards incidental to such participation, and I release the YMCA, supervisors, and coaches from any claim arising from an incident or injury to my child. I also understand that athlete's photo may be used for future promotional efforts. If I object, I must communicate via email or in written form with Jon Reimer, the YMCA's Activities Director. *
Required
How do you intend to pay for the $40 fee? *
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