IPSWICH GIRLS TRAVEL LEAGUE

							      IPSWICH TRAVEL BASKETBALL, INC.
                              REGISTRATION FORM
Please fill out one form per player. Players do not have to attend an Ipswich Public School to
be eligible to participate in the league – all private, home school and school choice students
are welcome.

2009 -2010 Registration fee        $140.00 per player.
Uniform costs:                     $ 45.00 per player (see Order Form on page 3)
Total cost with uniform:          $185.00

Multiple family member discount:
        Registration fee for 1 player           $140
        Registration fee for 2nd player          $ 90
Maximum family cap ($275 3+players)

Returning players do NOT need to purchase a new uniform.
The Registration fee should be made payable to Ipswich Travel Basketball, Inc. This fee
covers the costs associated with league for the full 2009-2010 season, (league dues, insurance,
equipment and referees). Uniforms purchased will include a shirt and shorts which can be
used each year within the league, therefore reducing your annual costs in the future if you do
not need a new uniform.

Player Information: (Required)            Grade:

First Name:_____________________Last Name: ___________________________

Address:____________________________________________________________

Home tel #_____________________________ Cell #_______________________

   D.O.B._________________________ Uniform # _____________________
                                   Please indicate your current uniform
                                   number.

Parent/Guardian Primary Contact Information (Required)

First Name:_____________________Last Name: ___________________________

Address:____________________________________________________________

Home tel #_____________________________ Cell #_______________________

Work tel #________________________
Email:________________________________
Parent/Guardian Secondary Contact Information (Optional)

First Name:_____________________Last Name: ___________________________

Address:_________________________________________________

Home tel #_____________________________ Cell #_______________________

Work tel #________________________
Email:________________________________


Please add any comments, medical conditions, special instructions or other
information that may be important to the staff for the 2008-09 basketball
season.




I the undersigned parent/guardian certify that I am familiar with the contents
of this release and that I accept any and all responsibility for, and assume the
risk of any and all injuries to my child, which might arise either directly or
indirectly as a result of his/her participation in this program. I hereby express
release, discharge and hold harmless from any liability whatsoever, Ipswich
Youth Basketball, as well as the employees and instructors in their private and
individual capacities as they represent Ipswich Youth Basketball whether
salaried or voluntary.

Please sign your name
agreeing to the above statement:_____________________________________________________

Date:________________________
                                       ORDER FORM
******************************************************************************************************

UNIFORM ORDER :                                  $45 ($15 shorts/$30 shirt)
JERSEY:            Youth: S          M L                            Adult :         S      M       L     XL

SHORTS:            Youth: S          M L                            Adult :         S      M       L     XL



Some scholarships are available for those in need. Please contact a director for
information if needed.

Please return your completed registration form and check by October 31, 2009 to:
Treasurer/Ipswich Travel Basketball, Inc.
c/o Jim DeMarco
12 Hickory Lane
Ipswich, MA 01938
978-412-9042
Ipswich Travel Basketball, Inc.

We truly appreciate the tremendous financial support that is given by the parents of our
players. At the same time, we understand that occasionally parents run into circumstances
that result in a returned check or financial hardships which make it difficult to pay their
debts.

Ipswich Travel Basketball, Inc. considers NSF checks a serious matter. Unfortunately
fees for returned checks cannot be absorbed by the League. Please note that any fees we
incur for your returned check will be added to your child's registration fee; and we ask
that the balance be paid with cash or money order in that circumstance. All fees must be
paid in full prior to the first game. Player's whose fees remain unpaid, in full or in part,
may practice but may not play in games. In extraordinary circumstances ITB, Inc. offers
partial scholarships if the need is justified and discussed in advance. Please speak with
one of the members of our Board of Directors if you would like to discuss a scholarship.




                                                                                     For League Use Only:

                                                                                     Check #__________________

                                                                                     Amount $_________________