Wingo Little League Basketball Sign Up
Child's LAST Name *
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Child's FIRST Name *
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Child's School *
Child's Grade *
Child's Gender *
Child's Shirt/Jersey Size *
Parent/Guardian Emergency Contact (NAME) *
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Parent/Guardian Emergency Contact (PHONE NUMBER) PLEASE PROVIDE 2 NUMBERS *
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HEALTH INSURANCE COMPANY NAME *
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HEALTH INSURANCE GROUP/PLAN NUMBER *
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HEALTH INSURANCE POLICY NUMBER *
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HEALTH INSURANCE INSURER *
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Please list any ALLERGY, MEDICATION, or MEDICAL CONDITION that the player has. (If none, please type NA) *
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