KBA Sunday Men’s League Form

Team:___________________________

Team Captain Name:___________________ Home Phone:____________

Team Captain Address:___________________ City/ZIP:________________

Team Captain Email:_____________________ Cell #:_______________

Circle one:

Sunday Mens A Sunday Mens B Sunday Mens Corporate

Team or Individual Contact: All players must sign agreeing to waiver terms listed at bottom of form

PLAYERS THAT ARE NOT ON THIS FORM CANNOT PARTICIPATE IN ANY GAMES OR EVENTS.

NO PLAYER CAN BE ADDED TO ROSTER AFTER THE 3rd GAME

Roster: (Official roster with full payment must be turned in at the start of your third game)

Name Phone # Jersey # Signature

1)_________________________ _______________ ______ ______________________

2)________________________ _______________ ______ ______________________

3)________________________ _______________ ______ ______________________

4)________________________ _______________ ______ ______________________

5)________________________ _______________ ______ ______________________

6)________________________ _______________ ______ ______________________

7)________________________ _______________ ______ ______________________

8)________________________ _______________ ______ ______________________

9)________________________ _______________ ______ ______________________

10) ______________________ _______________ ______ ______________________

Team Deposit: $250.00 (due at sign-up) Signup Deadline: Jan 4, 2008

League Begins Sun, Jan 13

Total League Cost: $495.00 (due at the start of your third game)

I/WE recognize and understand that basketball is a sport involving risks not encountered in everyday play. With this understanding, in consideration of the Kentucky Basketball Academy permitting myself to participate in the basketball programs, I covenant and agree to indemnify and hold harmless and do release, requite and forever discharge, Kentucky Basketball Academy, its officers, coaches, referees, employees, volunteers and other such people as are connected with the league in any capacity, for any and all damages, claims, and/or liabilities arising out of any and all injury to or caused by myself. I hereby authorize any and all emergency medical treatment deemed necessary by any physician, nurse, or paramedic. A copy of this authorization shall be effective as the original. (Signature line above.)

__________________________________________________

Team Captain Signature

See www.playkba.com for schedules and game times!