Thank you for your interest in our Basketball league. Please print this form and fill out completly, and mail to Gateway Baptist Church no later than October 20th, 2007

Child's Name:
Child's Grade: (Please Circle Grade)
 K    1     2    3     4     5     6
Gender (Male or Female):
Address:
City:
Home Phone:
Work Phone:
Church Name You Are A member of:
Parents or Guardian:
SHIRT SIZE:
 YS    YM       YL    AS     AM       AL    AXL

List any medical problems the coach or league needs to be aware of: ____________________________________________________________________________
____________________________________________________________________________

I the parent or guardian of the player named above on this application understands that the Gate Way Baptist Church or SLAM basketball league is not responsible for any injuries or accidents that take place while on Gate way Baptist Church property. The parents or guardians are the ones responsible for any medical expenses that occurs while thier child is in this league. I the parrent or guardian also understands that my child is not covered under the Gateway Baptist Church (Who operates SLAM Basketball) insurance plan. In the case of emergency I the parent or guardian do give permission to Gateway Baptist Church to seek medical attention for the child named above.

PARENT OF GUARDIAN SIGNATURE: ______________________________ DATE: ______________
CHILD'S INSURANCE CARRIER _______________________________________________________
NAME OF PHYSICIAN _____________________________ PHONE NUMBER ___________________

FOR LEAGUE USE ONLY
TEAM ______________________________ COACH _______________________________

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