2018-2019 Akron Silver League Basketball Application

 Name (last)_________________________(first)________________Age as of 4/1/19_________

 Address____________________________ City____________________ Zip code__________-

 Phone (home)____________________ Business________________ Cell__________________

E-mail __________________________________________

  Please check attendance expectations ___100% ___90%___80%___70%___60%___ 50% or less.

            I _____________________________, as a member of Akron Silver Basketball, so hereby agree to all of its rules and regulations. I am active in the basketball program and fully understand that my participation will make me total part of the game and I agree; to follow the instructions given by the league coordinator, coaches, managers and officials designated to control the activities and will follow all rules and regulations of the site and the rules and regulations of the City of Akron Recreation Department.

            I indicate by my signature that I have had a recent physical exam or deem myself physically able to participate in any activity of the Akron Silver League Basketball. I further agree to assume all liability for my  actions.  

Signature________________________________________________Date________________________

Date fee paid_______________Check#____________Cash________Amount_____________________

In case of emergency call _____________________________ Phone # __________________________

My physician’s name_________________________________ Phone # __________________________

Any physical limitations ________________________________________________________________ 

Shirt size (circle one)         S          M          L          XL          XXL      XXXL

Gray shorts are required. 

First time players please rank yourself.

Above average,_______ average, ________ below average, ______________. (Check one) 

Please check your preference of play. Openings will be filled on a first come basis.

Half Court __________ $80 application _______________________________

Full Court  __________ $100 application _______________________________ 

I will agree to coach a team. (Check one) yes______________ no _______________.

Check made out and mail application to:

Glen Bole

1427 Greensburg Rd.                                        Phone 330-899-9983 or 330-328-2450

Uniontown, Ohio 44685

Due by October 20, 2018