SUMMER 2016
RAMAPO AMATEUR BASKETBALL ASSOCIATION
18+ ADULT BASKETBALL LEAGUE TEAM REGISTRATION FORM
at THE JOSEPH T. ST. LAWRENCE CENTER
COACH NAME: ________________________________ TEAM NAME: ________________________________________________
ADDRESS: _________________________________________________________________________ ZIP CODE: _______________
HOME PHONE: _________________________ CELL PHONE: ____________________ EMAIL: ____________________________
*Age as of 7/6/16*
Gender (circle one)
1. Participant Name: ______________________________ AGE _____ DOB: ___/___/___ HEIGHT______ WEIGHT______ M F
2. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
3. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
4. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
5. Participant Name: ______________________________ AGE _____ DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
6. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
7. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
8. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
9. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
10. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
11. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
12. Participant Name: ______________________________ AGE _____
DOB: ___/___/___ HEIGHT______ WEIGHT______
M
F
FEES: $800/ ADULT TEAM
Deposit due at time of Registration: $450.00
Payment in full is due prior to the start of the season. No exceptions will be made.
The Town of Ramapo does not offer accident insurance and I understand that our personal insurance bears primary
responsibility in case of accident or injury
__________________________________________________
Signature of Team Representative
_________________________
Date