WCCC Youth Basketball - Player Information
This information will only be used by WCCC to improve future communications.

A separate form needs to be completed for EACH player

	Parents Information Parent / Guardian * Father Mother Guardian Name * Address * City * Clemmons Lewisville Pfafftown Rural Hall Winston-Salem Yadkinville State * Zip Code * Phone Number * Email Address * Players Information Players First Name * Players Last Name * Age as of August 1, 2009 * Players Birthdate * Gender * Male Female Division Mini Mites Mites Jr. Midgets Midget Boys Midget Girls Junior Boys Junior Girls Team Name: *