* Required

*Last Name: *First: *Phone #:
Boys: Grade as of September 1, 2009.    Girls: Grade as of September 1, 2009.
*Age: *DOB: *Grade 09:
*Address: *City,State: *Zip:
*School Attending 09/10: *Coaches Names:
*Parent/Guardian First and Last Name(s):
(if different than player's)
*Address: *City,State: *Zip:
*Player's Cell Phone: *Home Phone:
Mother's Cell/Work Phone: Father's Cell/Work Phone:
*Health Insurance (Carrier, insured's name, Policy Number):
If you do not have a family physician and/or dentist and their phone numbers, enter "none" in specified text boxes below.
*Family Physician: *Phone #:
*Family Dentist: *Phone #:

PLAYING FEES ($100.00 drop fee withheld after Monday 6 pm)
GIRLS:  $475 (Team Blue/White/North 5 In-State Tournaments)  $700 (Team Gold 7 In/Out-State Tournaments)     
BOYS:  $475 (Team Blue/White/North 5 In-State Tournaments)  $700 (Team Gold 7 In/Out-State Tournaments)
              $900 (Team Elite 9 In/Out-State Tournaments-Elite Exposure Events)

Please make your check or money order payable to CMBC, Inc. You will be required to sign this registration form at the time of your scheduled tryout. A Minnesota Comets representative will have your form at tryout site. You will also need to submit your payment at this time. BIRTH CERTIFICATE: Must be PHOTO COPY of an official birth certificate. This is an AAU requirement for both boys and girls participation. There will be a boys Age Exception verification that will need to be completed by their school.
Please bring a reversable numbered jersey to tryouts.

Consent Waiver: I give my son/daughter permission to tryout and play for a "Minnesota Comet" team. I understand the fees that I am responsible to pay are due at the time of tryout. I further realize that if my son/daughter does not make a team, I will be refunded all monies which have been paid. I also know and accept the policy that there will be no refunds after the first team practice should my son/daughter decide not to play or is unable to participate for whatever reason.
Additionally, I agree to release Central Minnesota Basketball Club, Inc. (CMBC), also know as the "Minnesota Comets", and all participating school districts and gym sites of all liability related to accidents or injuries which might occur while my child is trying out or playing Comets basketball. I also give permission for emergency medical procedures to be administered if I cannot be contacted in the event of an emergency.

Medical Information:

* By checking this box, you verify that all information supplied is accurate, and you agree to the terms and conditions of the Minnesota Comets Basketball 2010 Online Registration Form specified above in the Consent Waiver.