Visionary Basketball Group

Visionary Basketball Group Registration Form

Player Information

Parent or Guardian Information

First Name

First Name

Last Name

Address

City

State

Last Name

Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

E-mail

Player Age

Grade

DOB

Gender

School

Shirt Size

Home Phone

Work Phone

Cell Phone

E-mail

Emergency
Contact

Phone

Program

Please add any comments, special instructions, or health issues we should be aware of that would impact
participation in the program, camp or tournament.

Please read, check and type your full name agreeing to this statement.

Health Waiver and Disclaimer. I certify that I am familiar with the contents of this release and that I accept any and all
responsibility for, and assume the risk of any and all injuries to my child, which might arise either directly or indirectly as a
result of his or her participation in these programs. I hereby express release, discharge, and hold harmless from any
liability whatsoever, Visionary Basketball Group, Inc., as well as the employees and instructors in their private and
individual capacities as they represent Visionary Basketball Group, Inc., whether salaried or voluntary.

Name

Be sure all information is accurate before submitting the form.

PLEASE ONLY PRESS THE SUBMIT BUTTON ONCE - A CONFIRMATION LETTER WILL APPEAR
SHORTLY

"I never looked at the consequences of missing a big shot... when you think about the consequences
you always think of a negative result. " -- Michael Jordan

Registration Form and Medical Consent

Tournament teams: Click here to print summer registration information.
Please complete the registration form below and submit your information. If you wish to register and pay by mail,
please complete this form, print and mail with payment to Visionary Basketball Group, Attn: Program Registration,
P.O. Box 5005, Andover, MA 01810.