Plainville Girls Travel Basketball

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2018 Plainville Girls Travel Basketball Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street Address:

Plainville, CT 06062

Grade:

Birthdate:

PARENT/GUARDIAN

Firstname:

Lastname:

E-mail Address:

E-Mail Address:

Home Phone:

Work Phone:

Cell Phone:

Please complete if player needs a Uniform

YOUTH:

ADULT:

UNIFORM NUMBER - THIRD CHOICE:

UNIFORM NUMBER - FIRST CHOICE:

UNIFORM NUMBER - SECOND CHOICE:

Note: Per regulations, numbers 6, 7, 8, or 9 cannot
be used in uniform number
(example: 9, 17, 56 not allowed)

Shoe Size:

Please identify any reoccurring activities/ days (ex. gymnastics on Tuesday nights) that will conflict with practices. Accommodations will try to be made:

Please identify any medical conditions coaches should be aware of:

* indicates required fields

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2018 Plainville Girls Travel Basketball Registration