Player Information

Name: First      Last

Birthday: Month Mo. Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Year 1995 1996 1997 1998 1999 2000 2001   Boy   Girl

Uniform Size: YS YM YL AS AM AL AXL   Uniform Number Preference: 1st Choice   2nd Choice

Note:  Only players ages 8 to 13 as of Aug. 1, 2009 will be allowed to participate in the 2010 basketball season.   

Current School: Grade: 2 3 4 5 6 7 8

Parent / Guardian Information

Name: First       Last

Home Address:

                  City: , Texas   Zip:

E-Mail (Mother):

E-Mail (Father):

Mother's Phone: Home  Work Cell

Father's Phone:  Home  Work Cell

Emergency Contact Information

Tyler Little Dribblers maintains a contact list at each gym during games to contact the parents or a specified individual in the event of an emergency.  Please direct us who you would like us to contact on your child's behalf.

1st Contact:  Mother's Home Phone Mother's Work Phone Mother's Cell Phone Father's Home Phone Father's Work Phone Father's Cell Phone

2nd Contact:  Mother's Home Phone Mother's Work Phone Mother's Cell Phone Father's Home Phone Father's Work Phone Father's Cell Phone

3rd Contact Name:   Relation:

                                Home Phone:       Cell Phone:

Medical Information, Medical Release

 and Emergency Treatment Authorization

By submission of my payment, I certify that I am the guardian of the above child and that I understand that Tyler Little Dribblers, its representatives, coaches and others associated with the league assume no responsibility in case of accident.  In my absence, I authorize and consent to immediate care and treatment by any physician, nurse, hospital or EMT if necessary due to injury or sickness to my child.  

Below are health condition that might affect my child's participation :

I agree to the authorization as stated above.

Other Information

Please enter comments, carpool request, coach preference or other information below:

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