Student Name *

First Name

Last Name

Team *

Boys

Girls

Parent/Guardian Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Signature *

I understand that checking this box and providing my name below constitutes a legal signature and that my FACTS account will be charged $250 when the season starts.