Lunenburg Jr. Basketball League
Sponsored By The Lunenburg Park Commission
2015-2016 Season Registration And Application
1st - 2nd - 3rd - 4th Grade
Name (Please Print)
Date Of Birth
Street
Telephone #
Parents/ Guardian Name
Email Address
Have you played in the LJBL Program before
Boys 1-2
Y
N
Grade
If yes has this information changed from last year?
Boys 3-4
Girls 1-2
Will a brother or sister be playing in this league? Yes No
Y N
Girls 3-4
If so Name __________________________
________________________________________________________________________________________
PERMISSION AND RELEASE
I/We the parents of the above named candidate for a position on a Junior Basketball Team, do hereby give my/our approval
to his/her participation in any and all League activities during the current season. I/We assume all injuries, risks and
hazards incidental to such participation including transportation to and from the activities; and I/We do hereby waive,
release, absolve, indemnify and agree to hold harmless the Park Commission, the Junior Basketball League, the sponsors,
the organizers, supervisors, participants, coaches, and persons transporting my/our son/daughter to or from activities for
any claim arising out of any injury to my son/daughter.
PARENT SIGNATURE
GUARDIAN SIGNATURE
There is a $60.00 for 1 child or $100.00 PER
FAMILY registration fee.
Family rate does not apply to Middle School Program.
CHECKS MADE PAYABLE TO: LUNENBURG JUNIOR BASKETBALL
The purpose of the league is to learn basketball, show good sportsmanship, and HAVE FUN!!
________ Check if interested in Coaching.
Mandatory Registration Dates
Tuesday
Wednesday
October 5, 2015
October 6, 2015
6:30 - 8:00 pm
6:30 - 8:00 pm
TEEN CENTER
Or
Mail before
October 26
Mail to:
Peter Patno
40 Gilchrist Street
Lunenburg, Ma. 01462
ANY REGISTRATION RECEIVED AFTER OCTOBER 26RD SUBJECT TO A $15.00 LATE FEE
Check out our web site at www.lunenburgjrbasketball.org