Truro Titans Youth Basketball Association (2019-2020) Registration Form

Player Information:
First Name:	Middle Name:			Last Name:
Mailing Address (street #):
Town/City/Community:		Prov.	Postal Code:
Date of Birth (dd/mm/yyy):		Grade:	School:
Health Card #:		Family Doctor’s Name:			Family Doctor’s Tel Contact #:

 

Parent Information:
First Name (s):		Last Name (s):
Mailing Address (street #):				Parent Date of Birth (needed for registration with Basketball Nova Scotia)   DOB:
Town/City/Community:		Prov.			Postal Code:
E-Mail Address:	Home Phone # (including area code):					Cell Phone # (including area code)
Emergency Contact (name):			Emergency Tel. Contact # (including area code):

 

Program Information (select ALL that apply)
Under 10 (Jr. NBA Program Ages 7 to 9 & U10 Jr. Mini Competitive Teams)	Age Guidelines (ages 7 to 9 - must not have turned the age of 10 as of Jan. 1st, 2020):	Cost:	Check Box: □
Ages 5 to 7 (Jr. NBA Rookie Division)	Age Guidelines (ages 5 to 7 or roughly grade primary and grade one)	Cost:	Check Box: □

 
Signature: _________________________________             Date: _________________________
By signing above you confirm the above information and that the Truro Titans Youth Basketball Association is authorized to use your child’s name and/or picture for media purposes.  The Truro Titans Youth Basketball Association is not responsible for any injuries occurring during Association basketball related activities.

http://trurotitansbasketball.goalline.ca/files/truro_titans_youth_basketball_association_printable_registration_form_2019_2.pdf