CONTACT INFORMATION

Players Name: ________________________________________

 Players Home Phone: _____________________

 Players Cell Phone: _____________________

 Players Email:________________________

 Players Address:______________________________________

 City:_____________________    State:____      Zip:___________

 Fathers Name: _______________________________________

 Fathers Phone: _______________________

 Fathers Email: ________________________

 Mothers Name: _______________________________________

 Mothers Phone: _______________________

 Mothers Email: ________________________

PLAYER INFORMATION

Height:__________                          Weight:___________

 Birth Date:_______          Jersey Size:__________

 Shoot:__________                          Position:____________

 Winter Club Team:________________   Winter Club Coach:_______________

 Coach Phone:______________              Coach email:______________

 High School Team:________________   High School Coach:_______________

 Coach Phone:______________               Coach email:______________

How To Register

• Fill out this registration application. Applicants should be at Tier one or top Tier two playing level.
• Copy of Birth Certificate. (Only required if selected to the team)
• Send completed application along with $200 deposit (If you are not selected your check will be returned.)

Payable to Bike Line Selects

700 Lawrence Drive

West Chester PA 19380

www.bikelineselects.com