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BLACKSTONE – MILLVILLE YOUTH BASKETBALL LEAGUE
2017-2018 Season
Player’s Name: _______________________________________________________________________
Address: ___________________________Town: ______________________ ZIP Code: __________
Telephone No.( )__________________ Cell No. ( ) ______________________________
Gender: Male - Female Date of Birth: _________________ Shirt Size _______Youth or Adult
Grade: _____________________ Playing Experience: Novice - Intermediate - Advanced
Mother’s Name: _________________________ Father’s Name: _______________________
Please indicate if you can volunteer to coach or assistant coach: Y/N Position__________________________
Email Address: ________________________________________________________
Emergency Contact: (Someone other than parent) Name: _____________________________________________
Relationship: _________________________Telephone: ( ) ________________________________________
Any Medical Conditions the league should be made aware of? ___________________________________________
I/We the parents or legal guardian of the above named candidate for the position on a Blackstone – Millville Youth Basketball League team hereby give my/our permission to his/her participation including transportation to and from the activities: and will hereby waive, release, absolve, indemnify and agree to hold harmless the Blackstone – Millville Youth Basketball League, its organizers, sponsors, coaches, participants and persons transporting my/our child to and from activities, for any claim arising out of injury to my/our child, except to the extent and in the amount covered by accident or liability insurance.
Signature of Parent(s) or Guardian(s):____________________________ _____________________________
Date: __________________________
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Travel Team Try-outs at Hartnett Middle School:
Grade 4 Boys: Wed, Oct 4th & Wed, Oct 11th 6-7
Grade 5 Boys: Mon, Oct 2nd & Mon, Oct 16th 6-7:30
Grade 8 Boys: Thurs, Oct 12th & Thurs, Oct 19th 6-7:30
Travel League Season: Sun, November 26 – Mid March
*If you are interested in coaching a travel team for another age group, please let us know.
Player Evaluation for Town League:
Wednesday, November 15th at Hartnett Middle School:
Grades 3 & 4 Co-ed 6-7 PM
Grades 5 & 6 Co-ed 7-8 PM
Thursday, November 16th at Hartnett Middle School
Grades 7 & 8 Co-ed 6-7 PM
Town League Season: Sat, Dec 2nd – Mid March
FEES:
Town League: $55 one child, $85 for two children, $105 for three children
Travel: $130 Per child
Check off all that apply:
Coed, grades- 1-8 _________
Girls only – grades 5-8 __________
Travel -___________
Please make Check out to: BMYBL
Mail to: BMYBL
131 Mendon St.
Blackstone, MA 01504
Or register in person at player evaluations.
Contact: [email protected] or 508-883-9158
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