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Second Annual Phillip Gerlach Memorial 3 on 3 Basketball Tournament Date: April 26, 2014 Start time: 9:00 a.m.

Place: Jefferson High School 5707 Williams Rd. Monroe, MI 48162


(Team Captains: Please include a team name. Each team member must fill out a form. Please give all forms and money to Samantha Gerlach(734-770-0319) or send them to P.O. Box 24 Newport, MI 48166. Registration due by April 19th.)

Name:
(First) (M) (Last)

Age: D.O.B: M/F: Address:


(Street) (City) (State) (Zip Code)

Phone:

(Alternate):

I, , agree to play in the Phillip Gerlach Memorial 3 on 3 Basketball Tournament 2014 and abide by all rules and regulations and request that this registration form be accepted. In consideration of myself/my child being permitted to play in said tournament, my/my childs heirs, executors, administrators and assigns, waive and release any and all rights and claims for damages and losses myself/my child may have against the Phillip Gerlach Memorial Scholarship Fund and/or member units and/or its respective agents for any and all injuries suffered by myself/my child during the length of this contract.

Signed:
(player) (print name)

Signed:
(parent/guardian: if player is under 18) (print name)