2017-2018 Cosgriff Basketball Registration
Girls & Boys Basketball 2nd-8th Grade
School Attending 2017-18 *
Registered Parish *
Athlete must attend JE Cosgriff School or family must be parishioners of St Ambrose in order to register.
Your answer
First Name *
Your answer
Last Name *
Your answer
Gender *
Grade *
Player Experience and Skill Level *
Required
If you could choose ONE classmate or friend to be on your team who would it be?
Your answer
Parent/Guardian #1 (First and Last Name) *
Your answer
Parent/Guardian #1 (Phone) *
Your answer
Parent/Guardian #1 (Email) *
Your answer
Parent/Guardian #2 (First and Last Name) *
Your answer
Parent/Guardian #2 (Phone) *
Your answer
Parent/Guardian #2 (Email) *
Your answer
Emergency Contact (First and Last Name) *
Your answer
Emergency Contact (Phone #) *
Your answer
Emergency Contact (Email) *
Your answer
Relation to Student Athlete *
Your answer
As a Parent I am willing to? *
Safe Environment and Background Check with St Ambrose? *
Sportsmanship Motto *
Let the players play, Let the coaches coach, Let officials officiate, Let the spectators cheer positively
Consent to Participate *
Required
Youth Code of Conduct *
Permission to Use *
Participant Uniform Shirt Size *
Participant Uniform Short Size**
If different than shirt size**
Your answer
Healthy & Fit to Play *
Relevant Medical Conditions? *
Your answer
Contagious Diseases? *
Your answer
Current Medications? *
Your answer
Medical Treatment *
Insurance Information *
Your answer
Liability Release and Waiver Agreement *
Required
Participation Fee $100 (Charged to FACTS account on 10/24) *
Required
Late Fee $25 (After 10/23) *
We will not be able to accept registration after 3pm on 10/27
Required
Sponsorship or Donation
Your answer
Grade levels that require two or more teams will be determined by school Athletic Directors and Administration with a fair and balanced approach. *
Electronic Signature *
Your answer
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