Vipers A.A.U. Girls Basketball
Player Registration Form
Player Name ______________________________________________
NEW ____ RETURNING _____
Street __________________________________ Town ____________________ State ____ ZIP ________
Home # _____________________ Cell # ____________________ Email __________________________
Date of Birth ______________ Current Grade _____ Health Insurance? Y / N
Need uniform? Y / N
Uniform size: JERSEYS Youth S M L or Adult S M L XL - SHORTS Youth S M L or Adult S M L XL
Parent / Guardian Name _________________________________________________________________
Address ______________________________________________________________________________
Home # _____________________ Cell # ____________________ Email __________________________
Any special restrictions or health issues? ____________________________________________________
Player Fees 2017: NEW player fees for the Spring 2017 season are $325.00. This fee provides AAU
membership, your own full uniforms (home and away), insurance, all tournament fees, practice
facilities, equipment, and club administrative costs.
RETURNING players (with uniforms) fees are $250.00. This includes all expenses listed above. Uniform
replacement costs are extra!
PLEASE MAKE CHECKS PAYABLE TO: Vipers AAU Basketball
Consent: I hereby give my permission for ____________________________ to participate in Vipers AAU
Basketball during the 2017 season. In the event of an injury or illness to my child, I hereby grant
authority to a qualified physician, Emergency Technician, or Coach to render such treatment as deemed
necessary under the circumstances.
Parent / Guardian Signature: _________________________________________ Date __________
Waiver of Liability: My child and I are aware that participation in Vipers AAU Basketball is a potentially
hazardous activity. I assume all risk associated with participation in this sport, including, but not limited
to falls, physical contact with other participants, the effects of weather, traffic, travel and other
reasonable risk conditions associated with the sport and program. All such risks are known and
appreciated by me.
Parent / Guardian Signature: _________________________________________ Date ___________
For more information please visit our website: www.vipersbasketball.org