P.O. Box 906, 145 Queen St. South
Mississauga, ON, L5M 2L0
Tel: 905-569-MWBA (6922) Fax: 905-569-6929
Registration Print E-mail
Mississauga Wolverines | Elevating Your Game

Spring League
From Sat. March 27 to Sat. June 12, 2010

Location: Jeunes Sans Frontieres School, 7585 Financial Drive, Brampton

Registration Form: Please complete the form below and submit.

Program:
Ages: 5 - 7 years old
Time: 9:00 a.m. to 10:30 a.m.
Cost: $200
Ages: 8 - 10 years old
Time: 10:00 a.m. to 12:00 p.m. Noon
Cost: $225

Information type

Family Guardian

Parent/Guardian 1:  
Relationship: Mother Father Other
Salutation: Mr. Mrs. Ms. Other
Last Name:
First Name:
Home Telephone:
Business Telephone:
Cellular Telephone:
Fax Number
Email:
Parent/Guardian 2:  
Relationship: Mother Father Other
Salutation: Mr. Mrs. Ms. Other
Last Name:
First Name:
Home Telephone:
Business Telephone:
Cellular Telephone:
Fax Number:
Email:
Secondary Contact (if above cannot be reached):  
Name:
Telephone Number:
Relationship to Participant:
Mailing Address of Family:  
Street:
City:
Postal Code:
Billing Address:
(If it is the same as mailing address, please enter the word "same" in every field.)
Street:
City:
Postal Code:
Phone Number:
Athlete Information:  
Surname:
First Name:
Commonly Used Name:
Sex: Male Female
Birthday:
Health Card Number:
Previous Basketball Experience (if any):
Uniform Size:

Youth: S M L XL

Adult: S M L XL XXL

Medical Information:  
Height (inches):
Weight (lbs):
Allergies:
Requires an Epi-Pen: Yes No
Immunizations Up to Date: Yes No
Is the athlete taking any prescription medication: Yes No
Please list any other medical concerns:
Doctor's Name:
Doctor's Telephone:
Please read the medical waiver.  
By checking this box, I am stating that I have read and agreed to the above medical waiver: Date:

Conditions of Registration:

  
Please read the terms and conditions.  
By checking this box, I am stating that I have read and agreed to the terms and conditions: Date:

Media Release:
I wish to support the Mississauga Wolverines, a non-profit organization. I allow photographs to be taken of my son/daughter playing basketball in order to support their multi-media promotional requirements for photographs, brochures, website and other marketing materials.

By checking this box, I am stating that I have read and agreed to the above media release. Do not check the box, if you do not wish to provide media release.
Date:

*THIS APPLICATION MUST BE COMPLETED IN FULL BEFORE BEING CONSIDERED.

*PLEASE SEND PAYMENT TO: P.O. Box 906, 145 Queen St. South, Mississauga, ON., L5M 2L0

*APPLICATION WILL NOT BE CONSIDERED UNTIL APPROPRIATE FEES ARE RECEIVED.
 
Current Programs

Spring League Starts March 27, 2010. Click here for location, fees and registration.


bb-girls

Are you interested in a Girls-only Skills Development Program?

E-mail Phil Dixon
info

VERY IMPORTANT NEW FEE POLICY FOR THE 2009 - 2010 SEASON...
Read more...
What the Parents Say About Us...
Direct feedback from our from parents in 2 years of surveys

"What is the best thing?... they are a local, committed organization... thank you especially to the volunteers!"

"The best thing... the way the kids learn to respect each other."

"They teach sportsmanship and teamwork. Thank you!"