Spring Season April 7 - June 16, 2010 Games Location - Lakelands Park MS Game Days - Weekdays and either Saturdays or Sundays. Practice - weekday once a week. Division I [Age 14 - 15] DOB after June 1, 1994 - Division II [Age 12 - 13] DOB after June 1, 1996 - Division III [Age 10 - 11] DOB after June 1, 1998 - All participants are guaranteed a team roster spot. APPLICATION Applicant Name: __________________________________________ Date of Birth: ___________ Address: ______________________________________________________________________________ Parent's Email: _________________________________ Telephone: _________________________ Emergency Contact Name & Telephone #: ______________________________________________ Height: ________ Weight: _________ School: _________________________ Grade: _____ [Fall 09] I hereby grant permission for my child to attend the basketball program supported by Jr. NBA and its member MIBG. I understand that I am responsible for my child's insurance in case of injury. Furthermore, I understand that although safety precautions will be observed, Jr. NBA, MIBG, their employees and agents will not be responsible for any personal lost by my child or for any injury sustained in the program. I also consent to Jr. NBA and MIBG for the use of any photographs and videotapes made of the program. Please make $ 175 check payable to MIBG - 267 Kentlands Blvd. P.O.Box 1062 Gaithersburg, MD 20878 Please attach your business card for contact information. Parents/Guardian Signature: _____________________________________ Date: _______________