AECC Travel Basketball

Division

Players First Name

Players Last Name:

Birth Date:

Parent/Guardian Name:

Guardian Phone Number:

Guardian Email Address

Player Medical Information We Should Know (Type "N/A" if none)

Shirt Size

Jersey Number Preferred

Second Jersey Number Preferred (In case first number is taken)

INSURANCE INFORMATION/PERMISSION TO PARTICIPATE:

The AECC does not carry any Accident Insurance for its Youth Recreation Programs. In the event that your child is injured, the family’s insurance is responsible for paying any medical bills. By signing below, you agree to these conditions and giving your child permission to participate in

Parent/Guardian Signature:

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Payment Method

Online

In-Person (Please note: If this option is selected, payments MUST be made within 48 hours or form registration will be deleted)