Troy Hudson, S.I. Advance B-Ball Jam, Rashad Tucker, or S.I. Advance Boys & Girls High School Division Team Tournament. Fill in which tournament you are registering your team for.


____________________________BASKETBALL SUMMER JAM TOURNAMENT ENTRY FORM

MAIL TO: Carbondale Park District 2500 West Sunset DR. Carbondale, IL 62901 or Fax to 618-549-1873  

I understand there WILL NOT be medical insurance coverage for any injury I should incur while playing in this tournament or being a PARTICIPANT in any of the activities associated with this EVENT. In my own best interest, I realize I should have in effect medical insurance coverage, and that I will be responsible for providing proof of said insurance.
I HAVE READ AND UNDERSTAND THE FOREGOING AND SIGN IT VOLUNTARILY.

AGE GROUP: 9-11_____ 12-14_____ 15-17_____ 18-UP_____
BASKETBALL ROSTER - Maximum of 10

TEAM NAME:
CITY:
STATE:

COACHES / MANAGERS: PHONE # ADDRESS: CITY/STATE:
1.
2.

PLAYERS NAME: AGE: BIRTHDATE: SIGNATURE:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

I certify the above roster names have been completely checked for eligibility regulations. I will assume full responsibility for their eligibility.
COACHES SIGNATURE PHONE # ADDRESS

FOR MORE INFO CONTACT WALTER DAVIS AT 618-457-4707 (Home)OR 618-303-3706 Work )