Fremd Feeder Registration 2009-10
Players Name:________________________________________________________
Parents name:________________________________________________________
Address________________________________State:__________Zip:___________
Home #______________________Cell#___________________Wk.#____________
Email:_______________________________________________________________
DOB:_________________________Age:______________Grade:________________
School:______________________________________________________________
Emergency Contact: Name___________________________Phone:________________
Any health concerns:_____________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Insurance Co:__________________________________________________________
Policy #:______________________________________________________________
Waiver Signature:_______________________________________________________
(must sign to participate)
| Costs | |
| Player Fee (1st payment) | $425. due by 11/1/2009 |
| (2nd payment) | $265. due by 1/8/2010 |
| TOTAL DUE |
|
| Balance due by 1/8/2010 | |
Print and complete this form. Make check
payable to:
Fremd Feeder Boys Basketball
305 College Crossing
Rolling Meadows, IL 60008