PLAYER INFORMATION *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

AAU Expiration Date

MM

DD

YYYY

PARENT/GUARDIAN INFORMATION *

First Name

Last Name

Phone Number *

(###)

###

####

EMERGENCY CONTACT *

First Name

Last Name

Phone Number *

(###)

###

####

Physician

First Name

Last Name

Clinic Phone Number

(###)

###

####

LIABILITY WAIVER (Parent/Guardian Electronic Signature Required) *

As the parent and/or legal guardian of the above named minor, I grant permission to participate in all activities of the sports program. I assume all risk and hazards incidental to such participation, including transportation and from such activities, and do hereby release and waive all claims against SBA/Lynnwood Select Basketball Members, Staff, Coaches, Volunteers, Sponsors, and all School Districts we may participate in.

First Name

Last Name

HB 1824 COMPLIANCE STATEMENT (Parent/Guardian Electronic Signature Required) *

I have been provided with information on concussions in youth sports. If the player is suspected of a head injury or concussion, the player will be removed from play. The player will be kept from play until given permission to return to play by a health care provider. https://www.cdc.gov/headsup/youthsports/index.html

First Name

Last Name

CODE OF CONDUCT POLICY - COC (Parent/Guardian Electronic Signature Required) *

As the parent/guardian of the above named participant I understand the COC and agree to conduct ourselves as well as to ensure the above named participant understands and conducts themselves in a manner consistent with the league they're participating in. The parent/guardian as well as the participant must sign the COC before taking part in any Lynnwood/SBA Select basketball Feeder activity. Breaking a COC rule could result in your expulsion from SBA/Lynnwood Select Basketball Program.

First Name

Last Name

NO REFUND POLICY (Parent/Guardian Electronic Signature Required) *

I understand that there is NO refund policy once the season has begun.

First Name

Last Name