Atascocita Basketball Association
P. O. Box 2272
Humble, TX 77347
281-319-3ABA (3222)
website: www.atascocitabasketball.com
Registration No: _______
Spring 2017 Season
Pre-Registration Fee: $160.00
Registration Fee: $190.00
(Pre-Registration Fee must be rec’d by 2/26/17)
Make checks payable to ABA
Division: ________ Team_________
Coach__________
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Player Information
Last Name:
First Name:
Address:
City
Zip
Home Phone:
Date of Birth
/
/
Male or Female (please circle)
No. of Years Played
Grade
School Name:
Approx Height:______________ Weight:_______________
Jersey Size (Circle One):YS YM YL AS AM AL AXL 2XL
Shorts Size (Circle One): YS YM YL AS AM AL AXL 2XL
** $25 Sibling Discount per family. $160 or $190 fee for first child and $135 or $160 for each add’l child per household **
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Parent Information
(Please write legibly)
Father’s Name
Mother’s Name
Work Phone__________________________
Work Phone
Cell Phone __________________________
Cell Phone
E-Mail______________________________
E-Mail
Emergency Contact (Other than Parents)
Phone_______________
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Liability Release Agreement (Required)
I hereby give approval for the participation of my child in any and all activities sponsored or approved by the Atascocita
Basketball Association, and for child’s picture to be displayed on internet with first name only. The undersigned, being the parent or
legal guardian of the player named above, hereby agree to hold the Atascocita Basketball Association, Kiwi Properties, The Gym, its
officers, directors and coaches faultless in the event of injury or other harm occurring to the child, or loss of personal property during
the participation of all league events, including practices. Parent or guardian assures the league that adequate medical insurance is
available, and if necessary, parent or guardian will be responsible for any medical expenses.
Parent Signature
Date
(Please Print) Parent Name
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Volunteer Information:
Please indicate areas in which you can help on a volunteer basis: Coach
Team Mom __________Other______
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ABA USE-Do not write below this line
Treasurer Use ONLY:
Amount Paid $
Check No.
Received by:
Sibling Names
Cash______________
Date_______________
Sibling Divisions