Long Island Bulldogs Tryouts (Brentwood)

Step 1: Submit your information

Player's First Name *

Player's Last Name *

Date of Birth *

Sex *

Male
Female

Email *

Cell Phone *

Home Phone

School

Grade

Street Address

City

Zip Code

Player Shirt Size *

Facebook

https://facebook.com/

Twitter

Instagram

Snapchat

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Cell Phone *

Parent/Guardian Home Phone

Parent/Guardian Email *

Parent/Guardian Street (leave blank if same as player)

Parent/Guardian City (leave blank if same as player)

Parent/Guardian Zip (leave blank if same as player)

Parent/Guardian Facebook

https://facebook.com/

Parent/Guardian Twitter

Parent/Guardian Instagram

Parent/Guardian Snapchat

MEDICAL INFORMATION

Doctor's Name

Doctor's Phone

Medical Insurance Company

Group/Personal ID

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Preferred Hospital

Does your child have any medical disorders which might affect his/her playing ability or which might endanger other persons?

If Yes, please explain:

Authorization/Waiver of Liability *

In consideration of the acceptance of this application, I for myself, my child/ward, all executors and assignees, do hereby release and discharge Long Island Bulldogs Elite Basketball Club, Inc. and/or it’s directors, volunteers, and employees, for all claims, demands, or causes of action arising out of participation in both practices and games sponsored by the organization. I attest that I have full knowledge of the risks involved in strenuous athletic activity and that my child/ward is physically able to participate. I hereby authorize the designated volunteer or coaches of Long Island Bulldogs Elite Basketball Club, Inc. to act for me according to their best judgment in any emergency requiring medical attention. I further agree to be responsible for any medical or other charges in connection with my child’s/ward’s participation in any event sponsored by Long Island Bulldogs Elite Basketball Club, Inc.

agreed

If your child wears a medical alert bracelet or has such a condition, please bring this to the attention of the coach.

Step 2: Payment

To complete your registration, please click the “Buy Now” button below to pay. You will be redirected to our PayPal page for secure payment.

Questions? Please contact St. Jean Jeudy at: (631) 404 8628 sjeudy116@gmail.com and/or libeb116@gmail.com