The Form on this page is for late registrations for Intramural Only
This entire form must be completely filled out, signed by parent/guardian with a check in the amount of $105.00. Checks should be payable to "CRBA". Due to limited gym access and increased demand, registration for certain age groups may unfortunately be limited. Last year, players in several age groups that signed up late were unable to play. Players will be registered and accepted by date of receipt of completed registration form and payment. Boys and girls interested in travel program must must also complete the additional supplemental form.. No earrings or jewelry. Please allow 4-8 weeks for refunds which are subject to CRBA refund policy. Absolutely no registration accepted after draft or team selection, 5th grade and above.
Player Name (Last, First):___________________________________________________Circle One: Male/Female
Brth Date:____/____/____ Played in program last year (Yes/No) Grade:____________
Player lives with(Mother, Father, both, other):___________________ E-mail Address:________________
Height:(inches)___________ School:________________________Interested in Travel (Yes/No)________________
Children in grades 2, 3, & 4 only may request to be on a team with one friend_______________________
(Optional) 2-8th Grade: A maximum of one week night when student is unavailable for practice_____________________
Relevant Medical conditions (if applicable):__________________________________________________________
Street Address_______________________ City:___________________ Zip:__________ Phone:(215) ______________
Father's name:_______________________Mother's name:________________________________
Address and telephone numbers of parent(s) if different than player/child.
(Unfortunately, we can not guarantee placement on a team with friends)
(one day only, if more than one day chosen, your request will not be honored)
__________________________________ ___________________________________________
__________________________________ ___________________________________________
I/We, the parent(s) or guardian(s) of the above named child,
hereby give my/our approval to participate in any and all league activities.
I/We assume all risk 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 Council Rock Basketball
Association, its officers and board members, the Council Rock School District,
Northampton Township, their agents, board members, and employees, the
organizers, sponsors, coaches, referees, agents, coordinators, and persons
transporting my/our child to and from activities; for any claim arising out
of an injury to my/our child, whether the result of negligence or from any
other cause. I/We understand that the insurance carried by this Association
covers only the amount that is not paid by my/our insurance carrier. My
child is a resident of the Council Rock School District and/or the townships
therein.
Signature(Parent or Guardian)____________________________________________________Date________________
Coach________Assistant Coach________Coordinator________Gym Volunteer_________
Sponsor Team (include $125.00 payment) Sponsor's name______________________
(For Official Use Only)
Paid by Check#________ Cash _______
Click here for Skill Level Evaluation Dates
VOLUNTEERS ARE NEEDED.
VOLUNTEERS ARE NEEDED, The Council Rock Basketball Association is a non-profit
completely volunteer organization dedicated exclusively to children residing in the Council
Rock School District. Your help is essential. Please indicate below, how you would contribute to the
program.
Amount Paid: Registration $________ Travel $_______ Sponsor $_________ Number of Children Registered: _____
Thank you.