Last Update: August 17, 2011

Basketball Coaches Without Boundaries

BCWB Fall Basketball League 2011

(Individual Registration Form)

Individual Rate:


$130.00 Per Player

All Individual Players will be placed on a team

Sign-up deadline: Open Registration
Please complete the application below and return with payment to: (make checks and money orders payable to BCWB)

Basketball Coaches Without Boundaries

BCWB Fall Basketball League

P. O. Box 3528

Frederick, Maryland 21705

Player Name:________________________________   League ( ALL GIRLS   /  BOYS-COED)  Circle One


City, State, Zip:___________________________________________________________________________

Phone: _____________________  If desire specific team enter Coach/Team Name_______________________

Parent(s)//Guardian(s)  __________________________ Email:_______________________________________

Height/Weight: _______/_______Preferred Position: _________________  T-shirt size ____________________

Current School  __________________________________________ 2011-12 Grade Level ________________

High Level Played (circle all levels played, if any) 8th FR SO JV V  Other ____________

Total enclosed: $________________            Individual Fee:  $________  

 Medical Release  

The undersigned, being the player or parent/legal guardian of the player requesting league admittance, does hereby affirm that the applicant is in good health and suffers from no illness, disability, or condition that requires the taking of medication on regular basis unless that condition is disclosed and approved. Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity. The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any of the league supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent. I understand that, as a condition of admittance as a league participant, the undersigned, on behalf of all parents and guardians, and behalf of the applicant, hereby release Basketball Coaches Without Boundaries and all other employees or agents of the league from any and all liability in regards to injury or illness, either mental or physical suffered by the league participant during or related to the league by the person or entity against which the claim is made.

I have read the above and agree to the league conditions:

Parent Signature                                                                                                    Date:      _________________________________________________________         ___________