APPLICATION

Please cut along this line and return ONLY the bottom section. Make check payable to Apollo ABA, and mail to:

Steve Barker

Apollo ABA

2280 Tamarack Road

Owensboro, Kentucky 42301

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Name (First) _______________________________ (Last) _________________________ Grade ___________

Address __________________________________________________________________________________

School ________________________________________ T-Shirt Size Youth Size________ or Adult Size ______________

Boy _________ Age as of August 1, 2019 ___________ Date of Birth __________________

(Please list the best number to contact parent)

Parent Email _____________________________________

Mothers Name ____________________________________ Number (cell or work) _____________________

Fathers Name _____________________________________ Number (cell or work) ____________________

A recent physical is recommended. There is no league physician, and it is the responsibility of the parent or guardian to

obtain the exam. Apollo ABA Eagle Youth League does not provide health insurance; it is the parents/guardians responsibility

to carry insurance in case of accident or injury.

I, the undersigned, verify that my child is physically fit to participate in the Apollo ABA Youth Basketball League. We agree

not to hold the ABA or anyone associated with it responsible in case of accident or injury.

Insurance Company _______________________________ Policy # __________________________________

Signature of parent/guardian _____________________________________ Date ________________________

For more questions contact Steve Barker at 270-925-2742.