Fauquier Knights Recreational Basketball
Divisions: Boys Grades - K-3, 4-8 Girls Grades - K-3, 4-8
www.fauquierknights.com
*Season ends December 15*
Boys K-3___ Boys 4-8____
Girls K-3___ Girls 4-8____
Name__________________________ Grade____ School____________________________ Phone (____)_____-________
Address________________________________________________________Parent/Gaurdian_______________________
Work/Emergency Phone # (____)_____-________ Email____________________ _______________________
Physical Limitations: ______________________________________________ Doctor: _________________________
Medical Insurance: ___________________________________________ Doctor Phone # (____)_____-______
Are you interested in being a… (Please Circle) COACH REFEREE SPONSOR
Acknowledgement of Risk/Release of Claims Form
In consideration of the permission granted, I hereby grant permission for the person named on this form to participate in the program described and associated
activities sponsored by, FAUQUIER KNIGHTS, the county of Fauquier, its agents, employees, and its volunteers from all action, damages, claims, or demands
and liability which might be incurred during the conduct of this activity. I further authorize department officials and their agents to take the proper steps to
provide medical attention should the participant be injured while participating or being transported to or from any FAUQUIER KNIGHTS sponsored activity and I
hold said officials and Fauquier County officials harmless therefore. Read the policies pertaining to cancellations, refunds, rules, and regulations, etc., as they
pertain to this activity. I have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance.
Date: _________ Signature___________________________ Date: _________ Participant Signature_____________________________
CUT HERE------------------------------CUT HERE AND SAVE THIS PART----------------------------------CUT HERE
Commissioners
Boys & Girls K-3 - Stormie Malik - Stormsterhoops@aol.com
Boys & Girls 4-8 - Steve Malik - Kntbball@aol.com
Attach $75 Fee & Register with Fauquier Knights – 7507 Kennedy Road Nokesville Va, 20181
Registrations will be accepted up to the first game week.
Player evaluation Camp Sessions will be at: Boys and Girls – K-3 – September 13 & 20 – 8:30 AM – 10:30 AM
(Warrenton Middle School)
Boys and Girls – 4-8 – September 13 & 20 – 11:00 AM – 1:00 PM
There will be 2 camp sessions for players, coaches, and referees before the teams will be formed.
If you have any questions please contact the commissioner of your age group.
Let the 18th year of Fauquier Knights Basketball Begin!
www.fauquierknights.com - kntbball@aol.com