Ashley & Stephanie Daubs Memorial 3-on-3 Basketball Tournament

Team Registration Form:

Personal Information

Please enter all fields marked with a *

* First Name:

* Last Name:

* Address:

City:

* Province:

* Postal Code:

* Email Address:

Home Phone:

Work Phone:

Ext:

Mobile Phone:

Please check one of the following:

Male

Female

Divisions
Please check one of the following divisions:

Elementary Hoops - Co-ed Grades 1 & 2

Junior Hoops - Co-ed Grades 3 & 4

Intermediate - Grades 5 & 6

Future Stars - Grades 7 & 8

All Pro - Grades 9 & 10

Elite - Grades 11 & 12

Non-Competitive - Minimal/No Experience Mandatory

Family Division Experienced Player(s)

Masters – Open Division
At least 1 current or former college, university or professional player.

Masters –Competitive
No current college, university or professional player.

Team Name:

Player Four
Captain
Name:
Address:		City:
Postal Code:
Age:		Grade (current):
Home phone:		Email:
Player Two
Name:
Address:		City:
Postal Code:
Age:		Grade (current):
Home phone:		Email:
Player Three
Name:
Address:		City:
Postal Code:
Age:		Grade (current):
Home phone:		Email:
Name:
Address:		City:
Postal Code:
Age:		Grade (current):
Home phone:		Email:
Player Five ( with additional $10 fee)
Name:
Address:		City:
Postal Code:
Age:		Grade (current):
Home phone:		Email:

I have read the RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agree that no oral representations, statements or inducement contrary to anything contained herein have been made by The London Abused Women's Centre or Gold Medal Sports Camp Inc.
By submitting this form I agree to and accept all the terms and conditions mentioned in this release.

London Abused Women's Centre, 217 York Street, Suite 107 London, ON N6A 5P9
Phone: (519) 432-6858 Website: www.lawc.on.ca