Registration - Oak Mountain Girl's Basketball

Player Information
Player's Name*
First Last
Age*
Birth Date*
MM
DD
YYYY
Grade*
Height*
Shirt Size*
Years of Basketball Experience*
Did you play OMGBL last year?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
List any physical or medical limitations of which the coach needs to be aware:
Allergic to any medications:
Doctor's Name*
Doctor's Phone*
Hospital Preference*
Hidden
Insurance Company
Hidden
Policy Number
Parent Information
Parent's Name*
First Last
Home Phone*
Work Phone*
Cell Phone*
Email*
Parent's Name
First Last
Home Phone
Work Phone
Cell Phone
Email
Emergency Contact (other than parent)*
First Last
Relationship
Home
Work
Cell
I would like to:
- Head Coach
- Assistant Coach
Player Registration
Price:
Product Name
The undersigned parent or guardian understands that their daughter will be engaging in physical activity during league practice and games and that there are inherent risks of physical injury and the undersigned assumes the risk and releases the OMGBL, OM High School, OM Middle School, Shelby County Board of Education, its officers, director agents and employees from any and all liability for personal injury arising out of your child's participation in the league. I hereby authorize officials, coaches, assistants, team parent or any responsible persons delegated to any of the above to take my child to the nearest hospital or any accredited medical establishment for emergency treatment in case of injury during practice and/or games if the parents are not available. She is physically fit according to our family physician, and I further agree to pay through my insurance company or otherwise for any medical treatment that may be necessary.
Total
$0.00
Credit Card*
Card Details
Cardholder Name

Player Information

Parent Information

Information

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