BB L Step 3 Registration

Step Three: Activity Release Waiver / Woman's HS Basketball

* Indicates required field

Signature Of *

Parent Or Guardian Youth Participating In Event (14 Or Older

Name Of Family Physician or Practice *

Physicians Phone Number *

Insurance Company And Policy Number *

Does Your Child Have Allergies Or Medical Conditions We Should be Aware Of? If So Please Explain As Well As Any Authorized Medications. Please Include Amounts & Times To Be Administered Or Any Other Information. *

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