First Name *
Last Name *
Graduation Year *
Gender*
Position *
High School / Middle School / Youth Program*
2014 Playing Level *
Years Playing*
Age as of Jan. 1, 2015 *
Date of Birth (MM/DD/YYYY) *
Your email address *
Home phone number *
Cell phone number *
(yours or parents)
Address *
City *
State *
Zip Code *
Emergency Contact *
Emergency phone number *
Name of Insured *
Insurance Provider *
Insurance Policy Number *
Additional Information you would like to give:
LIABILITY RELEASE & WAIVER
Please read the following Liability Release and Waiver and place a check mark if you agree to the terms then click SUBMIT to send the form.

I have read and accept the terms of the Release and Waiver of Liability,  
Assumption of Risk, Indemnity and Parental Consent, and Use of
Photographs and Images AGREEMENT
(ABOVE)
SUMMER 2015 SILVERBACKS TRYOUT REGISTRATION FORM