2020 HORNETS JUNIOR REPRESENTATIVE PLAYER

All information provided in this document will be copied & kept by the Team Manager and Representative Manager. All information remains confidential.

1PLAYER INFORMATION > 2MEDICAL INFORMATION > 3BASKETBALL DETAILS > 4AGREEMENT
TEAM SELECTION
Type of Player
Please select Representative Team you have been selected within in 2020.
PLAYER DETAILS
Player's Name Player's Name First Last
Player's Date of Birth Player's Date of Birth / DD / MM YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone
Mobile Phone:
Parent (Guardian) Contact Details

Please provide contact details for player's mother.
Parent/Guardian Email address in which all communication will be sent:
1. Parent/Guardian Name: 1. Parent/Guardian Name: First Last
1. Parent/Guardian Mobile Mobile Phone
2. Parent/Guardian Name: 2. Parent/Guardian Name: First Last
2. Parent/Guardian Mobile Mobile Phone
Please provide any information regarding home life that the Coach or Manager should be aware of.
EMERGENCY CONTACT:

(Other than parent).
Emergency Contact Name: Emergency Contact Name: First Last
Emergency Contact Mobile Phone:
SIBLING DISCOUNT
Hills Basketball Association offers a sibling discount for families who have more than one child playing in our Representative program. Please list the names of children from your family involved in Hornets 2020 Representative Program. Discount will be applied to invoice.
Name #1 Name #1 First Last
Team
Name #2 Name #2 First Last
Team
Name #3 Name #3 First Last
Team