REGISTRATION FORM
Ways to register:  Print this form and mail it in or drop it off at the Church Office from 9 a.m.-1 p.m. Monday-Wednesday at 2445 Trebein Rd., Fairborn.

Child's Name  _________________________________________   

Address  ______________________________________________

City  __________________________    Zip Code  _____________

Phone #('s)  ____________________________________________

E-mail address  _________________________________________

School Grade  ___  Boy  ___  Girl  ___  Birth Date  _____________

*  Shirt size (circle one)  6-8(YS)  10-12(YM)  14-16(YL)  AS  AM  AL

*  pant size  _______

List anyone who you would like to be on a team with:

1.  ______________________________

2.  ______________________________

I agree to hold forever harmless the Berean Baptist Temple, its officers, members, employees, staff, etc., from any and all claims, injuries, and liabilities, arising from my own or my child's participation in the Berean Baptist Temple Basketball League.

Parent/Guardian Signature  _________________________________

Please print your name  ____________________________________

Date signed  ________________