ACADIANA BIDDY BASKETBALL                                    2010-2011

                   161 Vincent Road  Lafayette, La.  70508   

        ph (337-856-2763)                          fax(337-857-0499)

REGISTRATION:    

_____Boy   _____Girl       

Age Group:   ____5/6’s___7/8’s___9/10’s

How old will you be on  Sept. 1, of this year (2010)_____

Age___Grade____School____________________DOB____________                            

Name:__________________________________________________

Address:_________________________________________________

City___________________LA  Zip________HomePhone___________

Parent’s Names:___________________________________________

Parent’s #’s: Mom’s wk:_______________Mom’s cell_______________  

                          Dad’s wk:________________Dad’s cell________________

Email address(s) ___________________________________________________________________________________________________________

(email addresses are VERY IMPORTANT.  Most  communication throughout the season is done thru email , therefore if you have more than one address you would like to supply, please do so.)

Are you already covered by health & accident insurance?____yes_____no

Are you a _____returning player _____new player?

Text Box: T-shirt size: Youth Size__________Adult Size___________ Short size: Youth Size__________Adult Size___________

Text Box: Registration fee is $ 150.00 Payable to: Acadiana Biddy Mail to: Acadiana Biddy, 161 Vincent Road, Lafayette, La. 70508

 

For office use only__________________________________                              Date paid_____________

                                                                                            Amount paid________

                                                                                    Check#______________