Youth Basketball If you need to register more than one player you will need to register them one at a time.Player InformationPlayer Name*Please enter the player name. First Last Player's Address* Street Address City ZIP Code Sex*MaleFemalePlayer's Age*56789101112131415161718Player's Birthdate* Date Format: MM slash DD slash YYYY Did the player participate last year?NoYesCoach Last YearTeam / Division of PlaySchool*Grade*K5123456789101112Member of WPC?*SELECT ONEYesNoWestminster teams will average 10 players/team and adhere to CLBBY rule of no more than 2 visitors/team. Visitors from a church with no current basketball program or league affiliation will be added on a first come first served basis. Should a visitor attend a church in the CLBBY league, they will be asked to play with their home church. Contact WPC Representative Bryant Puntch at 915-5686 with questions.What church do you attend?*Parent InformationParent Name*Phone*Email* Parent Two NameParent Two PhoneParent Two Email Emergency Contact InformationEmergency Contact Name*Emergency Contact Phone*Medical Release AcknowledgementI will complete this form and return to my child's coach.*By checking this box, you are confirming you will print and complete the medical release form and give it to your child's coach at the first practice. This form must be submitted to qualify as an eligible player. Yes Insurance Company*Code of ConductI agree to the Player and Parent Code of Conduct*By checking this box, you are confirming you have read and agree to abide by the Code of Conduct policies. Yes CommentsIf you would like to share other information, request teammates, or ask a question please use the box below. CommentsPayment InformationPlease enter your credit card information below to make a secure payment.Total $0.00 Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.