For You Telecare Family Service 1133 Leslie Street, Suite 211 North York, Ontario M3C 2J6

Tel & Fax: (416) 447-3535 Crisis Line: (416) 241-5456

E-mail: info@futfs.org Web: www.futfs.org

“ Youth Basketball Tournament” Note: All information is confidential and will not be released without your permission

*REGISTER Date: / / MM / DD / YY

Name: __________ Last First Middle

Gender: M ( ), F ( ) Date of Birth: / / Grade: ( ) MM / DD / YY

Address: City Postal Code

☎: (H): (B): (C):_ ______

E-mail: ___________________________________________________________________

Emergency Contact: Relationship:

Name: Tel: Team Members (Team name : )

Name Grade Date of Birth MM / DD / YY

_ MM / DD / YY

__ MM / DD / YY

Registration Fee

Fee : $ 5 per player Signature: Date: