TIME 2 SHINE BASKETBALL

Name ________________________________________________________________

Address ______________________________________________________________

Phone & Alt. Phone _____________________________________________________

Valid Email Address ____________________________________________________

Height __________ Weight__________ D.O.B.___________

College/Coach_____________________________________ Yrs Played__________

Positions Played

Avg Pts_________ Shooting %__________ Avg Asts_________ Avg Rbds _________

Have you ever played professionally? Yes No

If Yes, list teams and dates. _________________________________________________

________________________________________________________________________

Valid State Drivers License Number__________________________________________

Do you have a valid Passport Yes  No

You are required to be covered by medical insurance. By completing this form you are signing confirmation that you are covered by your own health/accident insurance and you are in good health and release Time 2 Shine from all liabilities. Do you agree to these terms Yes No

Signed_________________________________________________ Date_____________

Office Use Only:

Fee paid________________________________________________ Date____________