Parent's First Name: *

Parent's Last Name: *

Your email: *

Retype email: *

Account password: *

Retype password: *

Street address: *

City: *

State: *

Zip code: *

Home phone: *

Cell phone:

Work phone:

Second email:

Player's First Name: *

Player's Last Name: *

Birthdate: *
M JanFebMarAprMayJunJulAugSeptOctNovDec D 01\n02\n03\n04\n05\n06\n07\n08\n09\n10\n11\n12\n13\n14\n15\n16\n17\n18\n19\n20\n21\n22\n23\n24\n25\n26\n27\n28\n29\n30\n31\n Y 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988

Grade registering: *
Please choose.. 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Junior Varsity HS Varsity

Preffered game day: (if applicable)
No Preference Friday Evenings Saturday Afternoons Sunday Evenings Saturday Evenings Sunday Afternoons

Gender: *

Shirt size: *
Select.. Adult Small Adult Medium Adult Large Adult XL Adult XXL Youth Large

Shorts size: *
Select.. Adult Small Adult Medium Adult Large Adult XL Adult XXL Youth Large

Shoe size: *
Mens Womens

Emergency contact: *
(add even if same as above)

Emergency phone: *
(add even if same as above)

Please add any comments, friends or teammates signing up, preferred town you want to play on if applicable, special instructions, other phone numbers or other information that may be important to us!

* I agree that I am authorized to fill out this form and register the above individual for the Eastern Basketball Program for 2008. I hereby represent the registered person and all parties, players, coaches, parents, guardians and representatives agree to hold harmless any and all persons involved in the Hamilton-Wenham Youth Basketball Program, HWYBI, HWYBB, Eastern Travel League, Cape Ann Travel League, Doug Lindland, and any employees, contractors, sub-contractors, officials, referees, board members and Hamilton-Wenham School and Gordon College system employees, agents, contractors, sub contractors and agents for any injuries, accidents, cancellations and other unforeseen events and circumstances.