STURGEON YOUTH BASKETBALL REGISTRATION

2013-2014 Season

Be A Bulldog!!
Teams are restricted to children with a parent or guardian residing in the Sturgeon School district and are in 3rd through 6th grade. Registrations due by October 4th, 2013 Registrations received after October 4th will be subject to a late fee of $20.00 per child. Coaches will be contacting players by the end of October. Each player will need a sports physical given to their coach the first practice. Separate registrations sheets are required for each child participating. Please make copies of this form as needed. Mail registration forms to: Misty Doss 512 Fairgrounds Sturgeon, MO 65284
I would be willing to (please check the box you are willing assist with): ____ ____ Head Coach Referee ____ Assistant Coach ____ Concessions to

_____ Serve on the Youth Board All families should check at least one.

BASKETBALL REGISTRATION / CONSENT FORM (Please print)

PLAYERS NAME: ______________________________________ Circle one: MALE / FEMALE PARENTS NAMES: ______________________________________ EMAIL ADDRESS ______________________________________ ADDRESS: ______________________________________ ____________________________-------__________ PHONE #: ____________________ GRADE THIS YEAR: ______AGE: ________

Jersey Size: $25.00

YM YL AS AM AL AXL

Registration Fee $15.00 Fees are for liability insurance and referee fees for the season

Baketball League Medical Information (Please Print)

Allergies: ____________________________________ Does your child have any specific medical problems, including asthma? Yes______ No _____ If yes, does your child take any prescription medicines or use an inhaler? Yes ____ No ____ If yes, please list: ________________________________________________________________________

(If your child uses an inhaler please have them bring it to all practices and games)
Which hospital does your family use for emergencies? ____________________________________ Do you have a specific physician who treats your child? If yes, whom__________________________ Yes ______ No _______

Permission to Treat
In my absence, I, ________________________________, the parent or legal guardian of _____________________________, give my permission for the examination and treatment of my child in the case of an injury or medical emergency suffered while involved in an activity sponsored by the Sturgeon Youth Sports Board. Signature of Parent of Legal Guardian: __________________________ ___________Date___________________ Home Phone: _________________________ Business Phone: _______________________ Emergency contact: __________________________________Phone Number: _______________________ *** Thank you. This information will help us to take better care of your child. ***