CDLL BASKETBALL REGISTRATION FORM
Players Name_________________________________________________  DOB_____________________
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Grade______________  Shirt size       YM        YL         YXL       AS         AM         AXL  ​​
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Parent/ Guardian _________________________________________________________________
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Home Phone____________________ Cell_______________________ Email_____________________________
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If a game is canceled due to weather how should we contact you?_______________________________________
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Emergency Contact  ( if parent can not be reached)___________________________________________________
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Relationship__________________________  Phone_______________________________
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Preferred Doctor ____________________________________________  Phone ___________________________
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Is your child currently under a doctors care or taking medication?   Yes     No    Explain_______________________
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Allergies? _______________________    Medical Condition _______________________________________
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Do you have health insurance covering your child?     _________  Yes  __________  No



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