AUSA Rampage

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AUSA SUMMER BASKETBALL LEAGUE 2025 AGES 6-14 BOYS 6-18 girls

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Home Phone:

* Age:

Birthdate:

* Email:

Gender:

Weight:

* Shirt Size:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

* indicates required fields

HEADLAND FAMILY MEDICINE

COOKIE'S RESTAURANT

RONNIE'S PAINT & BODY REPAIR

BISHOP FAMILY RESTAURANTS

Show Off Productions Screen Printing

DIXIE PEANUT COMPANY

ALL IN CREDIT UNION

M1 SUPPORT SERVICES

MILES OF FLOWERS

C&H TIRES

SOUTHERN SLEEP CLINICS

ST. COLUMBA CATHOLIC CHURCH FAMILY

Willie L.Brinkley

Debbie Brinkley

SCOTT'S CHAPEL HILL MORTUARY

AVADIAN CREDIT UNION

WIREGRASS MEN OF VALOR

TOWN OF KINSEY