September 24, 2011 whitbysaints Registration Player Information Choose Level Rep House League Last Name(required) First Name(required) Gender Male Female (required) Birth Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 (required) Birth Month January February March April May June July August September October November December (required) Birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 (required) Team Novice Development Program () Boys – Major Atom () Boys – Bantam () Boys – Major Bantam () Boys – Midget () Boys – Major Midget () Boys – Juvenile () Boys – Junior () Girls - Major Atom () Girls - Bantam () Girls - Major Bantam () (required) Hand Used Left Right (required) Height (in inches)(required) Weight (in pounds)(required) Size - Top Male - Small Male - Medium Male - Large Male - X Large Male - XX Large Male - XXX Large Female - Small Female - Medium Female - Large Female - X Large Female - XX Large Female - XXX Large Youth - Small Youth - Medium Youth - Large (required) Size - Bottom Male - Small Male - Medium Male - Large Male - X Large Male - XX Large Male - XXX Large Female - Small Female - Medium Female - Large Female - X Large Female - XX Large Female - XXX Large Youth - Small Youth - Medium Youth - Large (required) Health Card Number Cell Number (xxx-xxx-xxxx) Email(valid email required) Previous History Is the player a previous member of the Whitby Saints? No Yes (required) Was the Player a member of another club last season? No Yes (required) If yes, what was the name of the club? If you were a previous member of another club, please acknowledge (by answering Yes) that the player / parent has fulfilled the conditions of the OB Transfer Policy and secured a release from their previous club No Yes (required) Primary Parent/Gaurdian Last Name(required) First Name(required) Street Address(required) Unit or Apt # City(required) Postal Code (eg. A1A 1A1)(required) Home Number (xxx-xxx-xxxx)(required) Work Number (xxx-xxx-xxxx) Cell Number (xxx-xxx-xxxx) Are you willing to volunteer as a coach or manager? No Yes Email(valid email required) Secondary Parent/Gaurdian Last Name First Name Street Address Unit or Apt # City Postal Code (eg. A1A 1A1) Home Number (xxx-xxx-xxxx) Work Number (xxx-xxx-xxxx) Cell Number (xxx-xxx-xxxx) Email(valid email required) Sibling Information Please list names of the player's siblings who will be playing with the Whitby Saints this season. Confirmation I have read all information contained in the Whitby Saints Basketball Association registration package and hereby give my consent for the above named individual to participate with the Whitby Saints Basketball Association. I acknowledge that the information given for registration purposes to the Whitby Saints Basketball Association is true. I understand that falsifying any information on this registration for may result in the rescinding of the membership and the fees paid on behalf of the above named individual with the Whitby Saints Basketball Association. I hereby release the Whitby Saints Basketball Association, their agents, servants, volunteers, and staff from all claims for damages arising from any accidents or injury which are caused by or arise from participation of the applicant named on this registration form during any program or in any facility or at any location where an activity is being held Parent/Gaurdian Name(required) Picture (please attach head and shoulder picture) Proof of Age (eg. Copy of Birth Certificate) Verification I have read and understood the liability clause and the refund policy . (must be checked) Please send me a confirmation email Please retype the scrambled code shown below in the box; You have now completed the registration. Please press the "Register" button to submit the form. cforms contact form by delicious:days