Si

UMAAU Spring AAU “10” Basketball League Registration Form

General Information (please print clearly!)

Name:______________________________________________________________________

(Last) (First) (Middle)

Address:____________________________________________________________________

(Street) (City) (Zip)

Home Phone:________________________

Cell Phone:__________________________

Email: _____________________________________________

Email:______________________________________________

(Will only be used for UMAAAU Basketball communication)

Gender: Male /Female

Parent/Guardian Names:__________________________________________________

Date of Birth: ____/____/____ School: ___________________________Grade:______

Fee Information: $300.00 per player for 4th-5th-6th grades. ($250.00 for 3rd grade team) ( Make checks payable to UMAAU)

Amount Enclosed: ______________________ (Mail checks to UMAAU 517 Parkview Way Newtown PA 18940)

I/We the parents or guardians of the above name applicant for placement on a UMAAU team, hereby give permission for the child’s participation in any and all UMAAU activities. I/We assume all risks incidental to such participation, including transportation to and from the activities. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless UMAAU officers, directors, sponsors, managers, coaches, referees and persons transporting the child to and from activities from any claim arising out of injury to the child. I/We affirm that the child is in sound physical condition and that the child is covered by Health/Accident Insurance Independently. I have read the rules and the regulations of the UpperMakefield Basketball League and UpperMakefield AAU. I agree to abide by any decisions the Board of Directors may make with regard to the conduct of my family.

__________________________________________

(Parent or Guardian Signature and Date)

UMAAU Use:

Ck #:_____________

Amt Rcv’d: $________

Date: ____/____/____