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Maryland Queen's Competitive Tryouts
www.mdqueens.bmorecl.com

Development League Competitive Tryout Application

Women’s Blue-Chip Basketball League, LLC

www.WBCBL.com

Date: February 19, 2017        
          February 26, 2017
          $40 in advance
          $45 at door

Where: Leadership Through Athletics, Inc.
            2900 Hammonds Ferry Rd
            Lansdowne, MD  21227
Time: 9am to 12pm
Please be there an hour early

*Make Payment @ pay.mdqueens.com.bmorecl.com
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Email *
Try-out fee: *Make Payment @ pay.mdqueens.com.bmorecl.com Paying for one events covers both events. Please only pay for one event. You are required to attend both or one event. Please select dates to be evaluated? *
Required
Player Name *
Training camp is twice a week. Select the days your free after 4pm? *
Required
Any days with specific times *
Are you 21 years of age or older? *
DOB *
MM
/
DD
/
YYYY
SSN *
Address *
City, State, Zip Code *
Phone Number *
Email address *
Google Account Email address
Basketball level *
Required
Positon *
Required
College *
Point avg., Steals avg, Reb avg., FT avg, etc.. * *
Basketball Accolades *
(optional) Insert College website link with stats or game news
Do you Agree to email an upload of your player resume to MDQueens@BmoreCL.com *
Do you agree to participation in your media film recognition? When we send out any film or media you will be asked to evaluate the film? *
Important Notes:  Dress appropriately.·  No food or drink in the gym (except water).·  Keep the gym clean.·  The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced. Do you Agree? *
We have an Open Door policy to any questions or concerns that you may have. Do you agree to give 2 (two) weeks notice in the event that you must withdraw from our program or any commitment to any event or game that you will not be able to participate in, including our secondary young adult program? *
Emergency Contact & Health Insurance Information
Emergency Contact's Name *
Relationship to Emergency Contact *
Phone number *
Do you have Health insurance *
Required
Do you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? * *
Required
Please explain
Permission For Emergency Treatment
In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel and I authorize the person in charge to notify Emergency Contact:
I give consent for the facility to secure any and all necessary emergency medical care.
Name of Preferred Physician / Emergency Medical Care Facility *
Release of Liability
Although the safety of all sport activities is the primary concern, indoor sport activities at Sport Center's facilities may cause injuries and/or death.  I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Sport Center and the persons in charge.
I have read and agree to the above conditions *
Required
Confirm with E-mail *
Thank you for you participation
After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at MDQueens@BmoreCL.com. Please note your reservation is not confirmed until payment is submitted.
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