LBA Junior Basketball Application

Player Information
Emergency Contacts
Terms & Conditions
Payment

Player Information

First Name *

Last Name *

Sports League: *

Is he a returning player?*

Street *

City *

State *

Zip *

Date of Birth

Home Phone

Cell Phone *

Cell Phone 2

Email Address *

Yeshiva *

Rebbi *

Grade *

Height *

Rating: *

please answer accurately as it will affect the fairness of the teams

Location *

What Time Would You Like?*

Team Requests: We will try to honor all requests, but we cannot guarantee.

Please provide one or two names:

T-shirt Size: *

Terms & Conditions

TERMS & CONDITIONS

In the event of a medical emergency, I hereby give authority to LBA LEAGUES LLC staff to obtain necessary medical treatment for my child(ren).
I am aware that my son(s) will be playing athletic sports and participating in various activities as part of the program. I agree not to take any legal action against LBA LEAGUES LLC or its staff.
I will be held liable for any and all damages incurred by my child.
Agreement Not to Sue: You agree that you will not at any time maintain or file any lawsuit or assert any claim against LBA Leagues for any damage or loss related in any way.
I am allowing any images or videos of my child to used for LBA Leagues and FM Home Loans marketing platforms.

* I have read these conditions and agree to all of the above

Name: *

Signature *

Date *

Payment

Amount per child: $300 For 3 or more children there is a $10 discount per child

For additional payment options, please call/text/Whatsapp732-994-9780

Total:

Please Select Payment Method

Credit Card (There will be a 3% convenience fee for all credit card payments)

Card Details

Cardholder *

Card Number *

Month/Year *

CVV

Zipcode *

Check

Quickpay/Zelle

Checks must be received within 5 days of submitting the application. Checks should be made out to LBA LEAGUES and sent to 32 Cabinfield Circle, Lakewood, NJ 08701

Send payment to [email protected], payment must be received within 5 days of submitting the application. Please enter grade and name in memo line.

CONGRATULATIONS

Your LBA LEAGUES LLC application was successfully submitted!

Download the application form for each child:

You will also receive them to the email provided.

Text

Below is the LBA Application. Please note, you will be able to select your preferred gym location and time that your son would like to play.

TERMS & CONDITIONS

Card Details

Your LBA LEAGUES LLC application was successfully submitted!