Activities Ministry Basketball Registration Form

Church League Basketball 2007
Online Registration Form

Name: Address:

City: State: ZIP:

Email:

Phones (H): (C): (O):

Church Member: YES NO If YES, Where:

Birthdate: (mm/dd/YYYY) Sex: Male Female

Preferred Position to play:

List all medical problems your team should be aware of:

Doctor's Name: Doctor's Phone:

Doctor's Office Address:

Insurance Company:

Policy Number:

Emergency Contact Name:

Emergency Contact Address:

Emergency Contact Phones (H): (C):

Indicate which league you wish to register for:

Indicate if you have played in this league before:

You will NOT be registered or permitted to play until the insurance form, permission form and registration fees are turned in to the Activities Ministry office.

Be certain to complete the Insurance and Permission Form

If you have any questions about the activities ministry, recreation or sports at First Baptist Church, email us at activities@fbclagrange.org or call Gerry Lord at (706) 884-5570.