4th Grade Tournament Team Registration 2009

Players Name:________________________________________________________

Parents name:________________________________________________________

Address________________________________State:__________Zip:___________

Home #______________________Cell#___________________Wk.#____________

Email:_______________________________________________________________

DOB:_________________________Age:______________Grade:________________

School:______________________________________________________________

Emergency Contact: Name___________________________Phone:________________

Any health concerns:_____________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Waiver Signature:_______________________________________________________
(must sign to participate)

Jersey Size:  YM______YL______ AS______ AM______

Shorts Size:  YM______YL______ AS______ AM______

Fee:
Includes:	League fee, Tournament fees, Referee fees, Gym rental fees, Uniforms, Insurance
TOTAL DUE

Print and complete this form.  Make check payable to: 
Dale Monaghan
305 College Crossing
Rolling Meadows, IL. 60008