24th Annual League of Champs 2015 Registration

Pepsi & Q102 present the
25th Annual League of Champs 2015
SUMMER BASKETBALL LEAGUE FOR ORGANIZED TEAMS
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25 A
June 10th - July 15th
Wednesday Evenings
One Hour Sessions • 4-10 pm
New London-Spicer High School
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u Registration Includes u
• League Games/Round Robin Format
• Pepsi Team shirt must be worn each game
• Individual trophies for “League
Champs” for each member of team
visit our website at www.leagueofchamps.org
Tuition A registration fee of $45.00 will be due by April 1, 2015. There is a limit of 30 teams total for this year’s league. Minimum 8 players per team.
u Playoff game on final week only if there is a tie for First Place (by record) u
u Medical History u
Is there known history of:
A. Mental disorders or
convulsions
q Yes
B. Medical conditions currently
under treatment
q Yes
C. Preexisting injury currently
under treatment
q Yes
D. Allergy (drugs, food, etc.) q Yes
u Emergency Information u
q No
q No
q No
q No
EXPLAIN ABOVE QUESTIONS ANSWERED “YES”
____________________________________________
____________________________________________
____________________________________________
Call in case of an emergency:
NAME ____________________________________
PHONE NUMBER __________________________
Cash accepted or make check payable to:
LEAGUE OF CHAMPS, LLC
8925 71st Street NE • Spicer, MN 56288
League of Champs is a New London-Spicer
Community Education Program
Send registration to: League of Champs • 8925 71st Street NE • Spicer, MN 56288
u Parental Permit u
I hereby state that the League of Champs Basketball League
and/or NLS Community Education is not responsible for any
preexisting injury or recurrence of any undisclosed preexisting
injury or illness of the above player prior to the first day the
player registers. The league also assumes no responsibility for
injury or illness during the games.
The law requires that parental permission be obtained for
operative procedures on minors. The following consent form
should be signed by the parent so that such procedures may
be promptly carried out, and so that no unnecessary delays will
occur with operative procedures. However, no operation will be
performed, except emergency, without parents being
contacted and fully informed.
I give permission for such diagnostic, therapeutic and operative
procedures as may be deemed necessary for my daughter.
x
______________________________________________
Signature of Parent or Guardian
Pepsi League of Champs Basketball Registration
Date
April 1, 2015 Deadline
NAME __________________________________________________________________________________________________________________________
ADDRESS ________________________________________________________________________________________________________________________
CITY ____________________________________________________________________ STATE __________________________ ZIP ___________________
SCHOOL/TEAM NAME _______________________________________ HOME PHONE___________________________ ADULT SHIRT SIZE __________
GRADE NEXT YEAR__________ DATE OF BIRTH______________ COACH NAME ____________________________ PHONE ____________________
q $45.00 - April 1st Deadline
Please contact your coach
before registering.
Questions?
Call Lee Gauer 320-905-1936
q Entering Grade 6
q Entering Grade 7
q Entering Grade 8
q Entering Grade 9
q Entering Grades 10/11
— League Dates —
Wednesday Nights • JUNE 10th - JULY 15th
(Game schedules will be given to coaches and at 1st game)
Cash accepted or make check payable to:
LEAGUE OF CHAMPS • 8925 71st Street NE • Spicer, MN 56288