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WIA Express Player Information Form - Winter 2020
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* Indicates required question
Player 1 First Name
*
Your answer
Player 1 Last Name
*
Your answer
Address
*
Your answer
City, State, Zip
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
Your answer
Current Grade
*
Choose
3
4
5
6
7
8
School
*
Your answer
Additional Information about Player
Medical Conditions
*
Your answer
Eye Glasses or Contact
*
Eye Glasses
Contacts
Both
Neither
Allergies
*
Your answer
To the best of my knowledge I am able to play basketball with the associated conditioning at a high level of physical exertion.
By typing my name below, I acknowledge the above statement as a PLAYER.
*
Your answer
By typing my name below, I acknowledge the above statement as the PARENT of the player.
*
Your answer
Do you have another player on Express
Yes
No
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