Player Reg Form.xlsx - League Athletics

FBC  SOUTHEAST  ELITE  MEMBERSHIP  APPLICATION  2012 PLAYER  INFORMATION Player  Name: Date  of  Birth:

School:

Grade:  (2011-­‐2012):

Position:

Height:

Weight:

Uniform  Size  (circle  size):  

 Shorts  -­‐  YSelect S    YM    YL    YX      AS      AM      AL      AXL      AXXL  Jersey  -­‐  YSelect S    YM    YL    YX      AS      AM      AL      AXL      AXXL

Shoe  Size:   Womens  Shoe   Preferred  Jersey  #'s 1st  Choice

Men's  Shoe

T-­‐Shirt  Size  -­‐Select  YS    YM    YL    YX      AS      AM      AL      AXL      AXXL

2nd  Choice

3rd  Choice

State:

 Zip  code

CONTACT  INFORMATION Street  Address: City: Home  Phone: Cell  Phone:

Email: Facebook:

Father’s  Name: Wk  Phone:  

Cell  Phone:

Email: Mother's  Name: Wk  Phone:  

Cell  Phone:

Email: EMERGENCY  CONTACT  Name:

Cell  Phone:

Medical  Conditions Insurance  Carrier Policy  # SIGNATURES Signature  of  player:

Date:

Signature  of  parent:

Date:

FOR  OFFICE  USE  ONLY: Team  assignment:  ____________________________ Required  Documents  Received: FBC  Player  Commitment  and  Fee  Agreement: FBC  Standard  Form  Release  and  Indemnity: FBC  Player  Profile: AAU  Registration  Form: Birth  Certificate: Copy  of  Grade  Report:

Coach:________________________________