Eastside Basketball Registration (2018-2019 Season)
By filling out this form, I hereby give permission for my child to participate in the EASTSIDE BASKETBALL program.

I understand and agree that I am responsible for insurance coverage and neither the Eastside Basketball Program, Supervisors nor the associated facility may be held liable for any injury to my child while participating in the program.

I understand EBA is a volunteer run organization and that I will be required to volunteer during the season.

Tentative Tryout dates are Monday – Thursday, 9/10 – 9/21
You must attend all tryout dates for your grade.
Grades and times will be announced in the Perinton Post and on our website in late August/early September.

For additional info, call Tom Hendricks 585-481-6345 or Jamie Pucci 585-313-6585

Players Name *
Your answer
September 2018 Grade *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Boy / Girl *
Mothers Name *
Your answer
Mothers Phone Number *
Your answer
Mothers E-mail Address *
Your answer
Fathers Name *
Your answer
Fathers Phone Number *
Your answer
Fathers E-mail Address *
Your answer
Address *
Your answer
Doctor *
Your answer
Doctors Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Special Conditions
Your answer
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