Heroes Basketball - Team Roster - 2012 Team or Sponsor Name To Appear On Back Of Shirt: #
Print Name Clearly
Boys Street Address
Town e-mail address (required)
Girls Age Div: Phone
AGE RULE: We play CYO age rules. If
14 players maximum for each team. Uniform shirts are provided Just check box if Birth Certif. is on file. for 12. If need 14 Player can not be 11, 13, 15 or 18 by 12/31/2012, you must write it on the bottom of to be eligible for the lower age division. this form.
10 & under - born 2002 or later player has been in this league in the past, and 12 & under - born 2000 or later you have submitted a birth certificate, you 14 & under - born 1998 or later 17 & under - born 1995 or later need not present one when signing up here.
Date of Birth
*Guardian Signature
1 2 3 4 5 6 7 8 9 10 11 12 13 14 Coach Asst. Coach
work or cell work or cell
*It is the responsibility of the parent/guardian to make sure the child is medically fit to play in our league. By signing, the parent/guardian is stating that their child has had a medical examination in the past 12 months and are fit to play. Also parent/guardian understands that Heroes Inc. is not responsible for any injuries sustained during the activity. Furthermore, by signing, parent is stating that the league is not responsible for conditions of any playing surfaces. The parent/guardian hereby signs away liability to the league, its directors, coaches or referees. If parent feels that conditions are unsafe, it is solely their decision whether or not their child plays in the contest. List clearly here any days or dates your team can not play: (example: No Tuesdays, No Wednesdays in May, no weekends in June, etc.) **Heroes league will do all communications through the web site on the fact sheet. www.queensledger.com Return with fee by April 13th - Checks made out to “Heroes Basketball� Deliver at registration dates or c/o Queens Ledger 69-60 - Grand Avenue, Maspeth, NY 11378 - 718-639-7000