Eastside Basketball Association AAU Registration

Eastside Basketball Association

EASTSIDE
BASKETBALL ASSOCIATION

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2012 EBA-AAU Registration
*** BOYS ***
Completed Registration Form Due at first tryout / meeting,
along with attached copy of your birth certificate.
*** $50 REGISTRATION FEE - Due at your first practice once selected. ***
*** $20 FEE - will be charged for those who tryout. ***

(Click button above for Tryout Times)

Please print, complete and attach a copy of your birth certificate, $20 fee.
KEVIN LEGG // 871 MACEDON CENTER ROAD // FAIRPORT, NEW YORK 14450
Phone 585.425.1883
Make checks payable to Eastside Basketball Association.

AGE GRADE: DOB:
*a copy of your birth certificate must be on file prior to participating.

MOTHER'S NAME:
PHONE NUMBER:

FATHER'S NAME:
PHONE NUMBER:

ADDRESS:
E-MAIL ADDRESS:

DOCTOR:
PHONE NUMBER:

EMERGENCY CONTACT:
PHONE NUMBER:

SPECIAL CONDITIONS:

I hereby give permission for my child
to participate in the EASTSIDE BASKETBALL PROGRAM. I understand and agree that I am responsible for insurance coverage and neither the Eastside Basketball Program, Supervisors, or the associated facility may be held liable for any injury to my child while participating in the program.

SIGNATURE: ________________________________ DATE:

Kevin Legg - klegg@esbasketball.com or 585-425-1883

Eastside Basketball Association

EASTSIDE BASKETBALL ASSOCIATION
871 Macedon Center Rd., Fairport, New York 14450
Fax 585-421-9025 - Phone 585-425-1883
E-Mail klegg@esbasketball.com
E-Mail comments to: webmaster@esbasketball.com