MONTGOMERY SPORTS ASSOCIATION

TEAM REGISTRATION BY MAIL

Parents/Guardian and Player Consent

Parents and Players, please read and indicate your agreement by signing below:
I hereby approve my child's participation in the MSA Teams  and consent to emergency medical treatment for my child on my behalf.  To the best of my knowledge, there are no physical or other conditions, which will interfere with my child's participation. I have acknowledge and agree with MSA's no-refund policy, and that only an MSA  credit certificate will be issue for future MSA activities.
 

Sport:________________________________________________

School Location:________________________________________

Age Group:____________________________________________

Athlete's Name__________________________________ _______
SIGNATURE____________________________________ _______
                             (Please Print)
PARENT'S SIGNATURE _____________________Date__________
Player's Birth Date: Month _________Day ______ YEAR_________
Home Address__________________________________________

_____________________________________________________
 

__________________________________________________________________________                                                                                                      (City)                                                          (State)                (Zip)

Mom's Name:___________________________________________
Dad's Name:____________________________________________
Home # _______________ Mom's Work # _______________ _____
Dad's Work # ___________________________________________

Family Email: ___________________________________________
Grade ___School ________________________________________
Current Team___________________ Coach __________________
 

Only For MSA Hot-Shotz

AAU Membership Number _______________

Pay fee by personal checks and major credit cards (Visa, MC and Discover)

Payment Authorization

Parent Signature:__________________________

Payment Amount: _____________________________

Card Number:_________________________________

Expiration Date: ________________Zip Code________

Name of the Card Holder:_________________________

Address of Card billing address if it is different than the

home address: ____________________________________________
 

_________________________________________________________________________________                                                                                                      (City)                                                                                     (State)                (Zip)

Mail Registration & payment to:

MSA, 9334 Sprinklewood Lane, Potomac, MD 20854

To Download the registration Form Click here for the PDF File