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Bottineau County and City 125th Anniversary
3 on 3
Basketball Registration
www.bottineau.info
Team Captain
Address
City
State Zip Code
Home Phone Work Phone
E mail address Age Male Female
Emergency Contact Phone Number
Release and waiver (Please Read and
sign)
In consideration of my entry, I my heirs, executors and
administrators waive all claims , release from all liability and agree to hold
harmless Bottineau County 125th, it’s agents , sponsors for this
event for any and all injuries and damages suffered by me in connection with
this event. I understand that this tournament entails personal risk, including
serious bodily injury and even death, and I voluntarily assume that risk. I
recognize the physical exertion involved in the event and attest and certify
that I am physically fit to compete safely, and I have not been advised
otherwise by a health care professional.
1.
Player 1 Team
Captain Print name Signature for waiver Date Shirt Size
2.
Player 2 Signature for waiver Date Shirt Size
3.
Player 3 Signature for waiver Date Shirt Size
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If athlete is under 18
This will certify that my son/daughter has my permission to compete
in the Bottineau 125th Anniversary 3 on 3 basketball
tournament and officials have my permission to use emergency treatment
if necessary.
Signature of parent or
guardian Date
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Fees and Deadlines
Registration Cost Dates & Deadlines
Tournament will be held the afternoon of Saturday June 20th, 2009 at 2:00 pm
At the Bottineau High School Gymnasium
Pre Registration February 4th through May 22nd.
Pre registration $10.00 per person
After May 22nd $15.00 per Person
Registration Deadline Friday 30 min before game time.
Cash prizes will be given to winning teams.
Please fill out the race entry form completely and mail the form,
Including the total check amount to:
Bottineau 125th 3 on 3 Tournament
%Bottineau Technology Center
519 main St
Bottineau ND, 58318
Contact:
Dave Geisler: 701-228-2236
Gail Evenson: 701-201-0486
Bottineau Technology Center: 701-228-3252