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Our Lady of Guadalupe, Buckingham, PA
BASKETBALL 2020-2021
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Family Address
Primary Family Address
Family Name
Address
Father's Name
Mother's Name
Maiden Name
Are you interested in coaching?
No
Yes (Father)
Yes (Mother)
Yes (Both)
How did you find out about this Registration?
Returning player
Church Bulletin
After Mass Registration
OLG E-mail
OLG Website
OLG Mailings
CCD/Prep class
Friend
Other
Primary E-mail
Secondary E-mail
Optional
Primary Phone
Seconary Phone
Optional
Total Number of Children
1
2
3
4
5
Total number of children you will be registering today
Page Break
Player Information
Child 1
Sport
Basketball ($185.00 per Child)
Do you need a new uniform?
Yes
No
Player Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Our Lady of Mt Carmel
Cold Spring El
Gayman El
Groveland El
Buckingham El
Buckingham Friends
Bridge Valley El
New Hope/Solebury
Tohickon MS
Holicong MS
St Martin
St Cyril
CB East HS
Archbishop Wood
LaSalle HS
Plumstead Christian
Other
School
if not listed
Special Medical Conditions or Instructions (Explain condition or type 'none')
Child 2
Sport
Basketball ($185.00 per Child)
Do you need a new uniform?
Yes
No
Player Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Our Lady of Mt Carmel
Cold Spring El
Gayman El
Groveland El
Buckingham El
Buckingham Friends
Bridge Valley El
New Hope/Solebury
Tohickon MS
Holicong MS
St Martin
St Cyril
CB East HS
Archbishop Wood
LaSalle HS
Plumstead Christian
Other
School
if not listed
Special Medical Conditions or Instructions (Explain condition or type 'none')
Child 3
Sport
Basketball ($185.00 per Child)
Do you need a new uniform?
Yes
No
Player Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Our Lady of Mt Carmel
Cold Spring El
Gayman El
Groveland El
Buckingham El
Buckingham Friends
Bridge Valley El
New Hope/Solebury
Tohickon MS
Holicong MS
St Martin
St Cyril
CB East HS
Archbishop Wood
LaSalle HS
Plumstead Christian
Other
School
if not listed
Special Medical Conditions or Instructions (Explain condition or type 'none')
Child 4
Sport
Basketball ($185.00 per Child)
Do you need a new uniform?
Yes
No
Player Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Our Lady of Mt Carmel
Cold Spring El
Gayman El
Groveland El
Buckingham El
Buckingham Friends
Bridge Valley El
New Hope/Solebury
Tohickon MS
Holicong MS
St Martin
St Cyril
CB East HS
Archbishop Wood
LaSalle HS
Plumstead Christian
Other
School
if not listed
Special Medical Conditions or Instructions (Explain condition or type 'none')
Child 5
Sport
Basketball ($185.00 per Child)
Do you need a new uniform?
Yes
No
If you are a new athlete or a returning athlete who needs a larger size uniform please contact Coach Clare Daniels
clareodaniels@gmail.com
. Uniforms cost $25 and are yours to keep. We use the same uniforms for Cross Country and Track.
Player Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Our Lady of Mt Carmel
Cold Spring El
Gayman El
Groveland El
Buckingham El
Buckingham Friends
Bridge Valley El
New Hope/Solebury
Tohickon MS
Holicong MS
St Martin
St Cyril
CB East HS
Archbishop Wood
LaSalle HS
Plumstead Christian
Other
School
if not listed
Special Medical Conditions or Instructions (Explain condition or type 'none')
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Page Break
Emergency Contact
Emergency Contact Name
Relationship
Emergency Contact Phone
Terms of Service
APPROVAL TO PARTICIPATE AND LIABILITY RELEASE
I/We as parents or guardians of the above named child hereby give my approval for his/her participation in any and all of the activities of this program during the current season. I/We do further hereby release, absolve, and hold harmless the Youth Ministry of Our Lady of Guadalupe, the organizers, sponsors, supervisors, coaches and drivers of any of the organizations and programs in case of injury to my son or daughter. I/we hereby waive all claims against the organizers, sponsors, supervisors, coaches, and drivers or anyone appointed by them. I/We assume all responsibility for the entire medical payments not covered by Youth Ministry insurance.
I agree
PARISH ELIGIBILITY REQUIREMENTS
I/we agree that the child named above is a registered parishoner of Our Lady of Guadalupe parish and is attending either Catholic school, A parish PREP program or has been confirmed.
I agree
CONCUSSION AND CARDIAC ACKNOWLEDGEMENT FORMS
Sudden Cardiac Arrest Prevention Acknowledgment Waiver
By checking this box, I acknowledge that I have read and understood these forms.
READ MORE
.
PCC PIAA Concussion Waiver
By checking this box, I acknowledge that I have read and understood these forms.
READ MORE
.
Total Cap
Total Sports
Total Uniforms
Total Normal
Current Date
Total Amount
Verification
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SUBMIT FORM AND PAY