WIA Express Player Information Form - Winter 2020
Player 1 First Name *
Player 1 Last Name *
Address *
City, State, Zip *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Current Grade *
School *
Additional Information about Player
Medical Conditions *
Eye Glasses or Contact *
Allergies *
To the best of my knowledge I am able to play basketball with the associated conditioning at a high level of physical exertion.
By typing my name below, I acknowledge the above statement as a PLAYER. *
By typing my name below, I acknowledge the above statement as the PARENT of the player. *
Do you have another player on Express
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