CDLL BASKETBALL REGISTRATION FORM
Players Name_________________________________________________  DOB_____________________


Grade______________  Shirt size       YM        YL         YXL       AS         AM         AXL  ​​


Parent/ Guardian _________________________________________________________________


Home Phone____________________ Cell_______________________ Email_____________________________


If a game is canceled due to weather how should we contact you?_______________________________________


Emergency Contact  ( if parent can not be reached)___________________________________________________


Relationship__________________________  Phone_______________________________


Preferred Doctor ____________________________________________  Phone ___________________________


Is your child currently under a doctors care or taking medication?   Yes     No    Explain_______________________


Allergies? _______________________    Medical Condition _______________________________________


Do you have health insurance covering your child?     _________  Yes  __________  No



Do we have permission to transport your child by ambulance if necessary?  _____Y  _____ N 


Medical Release:  In case of emergency I hereby authorize my child to be treated by Certified Emergency

personnel (ie;  EMT, First Responders, ER Physician,  Hospital Personnel ) _______________________________

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________________________________________________________________Parent/ Guardian


Date ___________________________________

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The purpose of reporting the above listed information is to ensure that medical personnel have details of any/all

medical problems which may interfere with or alter treatment. ​​​​​
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