OBS - Application

Type your information into the following fields below. Upon completion, please click the PRINT button below to print out your completed application. Please sign, date, and mail your completed application and $200 check, add $50 if you're a new player or need a new uniform. Please make check payable to MIBG, mail to 267 Kentlands Blvd., PO Box 1062, Gaithersburg, MD 20878.

Applicant Name:
Date of Birth:
Format example: 01/02/2012
Street Address:
City: ,  State:   Zip Code:
Parent's Email:
Emergency Contact Name:
Emergency Phone Number:
School Grade:
(as of Fall 2017)
School Name:

I hereby grant permission for my child to attend the basketball program supported by OBS and its member MIBG. I understand that I am responsible for my child's insurance in case of injury. Furthermore, I understand that although safety precautions will be observed, OBS, MIBG, their employees and agents will not be responsible for any personal lost by my child or for any injury sustained in the program. I also consent to OBS and MIBG for the use of any photographs CDs, and videos made of the program.

_____ Attached $200 Registration Fee

_____ Attached $50 Uniform Fee

Parents/Guardian Signature:________________________________________________________