Group *

First Name *

Last Name *

Grade *

Year of Birth *

Postal Code *

Email *

Main Contact Number *

Cell Phone

Parent Name: *

Parent Contact Number: *

Emergency Contact Name: *

Emergency Contact Number: *

Health Card Number: *

Medical Conditions and/or Allergies: *

Local Masjid

Height

Jersey Size *

What MBA Team did you play for Last Season *

Basketball Experience *

Suggestions or Comments About the MBA

Liability Release/Waiver: By submitting this form I am releasing the MBA League and all staff, volunteers, associates, sponsors and facilities from responsibility of any injury or damages that might occur during My Child's Participation in the MBA. I hereby authorize MBA League staff to act for My Child according to their judgment in any emergency requiring medical attention and I hereby waive and release the MBA League and its Volunteers from any and all liability stemming from any injuries or illnesses incurred while My Child is participating in any MBA Activity. I have no knowledge of any physical impairment which would be affected by My Child's participation in the MBA League. I understand that MBA League games and Practices consists of strenuous physical activity. *

Media Release: I hereby give permission for my child to be photographed & filmed during the league's activities. I understand the photos will be used to keep a journal of activities, to share during presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper, social media and on our & sponsors website. *