TEAM NAME:________________________________
Division of play Male Female
4th 5th 6th
7th 8th 9th/10th
11th/12th 30 & Under Over 30
Open (Check Male or Female and one other box)
3-on-3
Basketball
August 13, 2005

Mail with $85.00 entrance fee to:
Little Panther Shootout
PO Box 584
Cedar Falls, IA 50613
ENTRIES MUST BE POSTMARKED BY
SATURDAY, JULY 9, 2005

Player #1 (Captain)
Name_____________________________________
Address____________________________________
City__________________ Zip___________________ Phone____________________________________
Birthdate_____/_____/_____ Grade__________ (next school year)
I waive and release any and all claims for damages that I may incur as a result of my participation in the LIttle Panther Shootout against Price Laboratory School, NU Booster Club, Inc., the University of Northern Iowa, all sponsors or any employee, volunteer, official or elected official of these organizations for said injuries. I further certify that I have full knowledge of the risks involved in this event, and that I am physically fit to participate.
T-Shirt Size S M L XL XXL

___________________________________________
signed (parent or guardian signature if participant is under 18 years of age.)
Player #2
Name____________________________________
Address____________________________________
City__________________ Zip___________________ Phone____________________________________
Birthdate_____/_____/_____ Grade__________ (next school year)
I waive and release any and all claims for damages that I may incur as a result of my participation in the LIttle Panther Shootout against Price Laboratory School, NU Booster Club, Inc., the University of Northern Iowa, all sponsors or any employee, volunteer, official or elected official of these organizations for said injuries. I further certify that I have full knowledge of the risks involved in this event, and that I am physically fit to participate.

T-Shirt Size S M L XL XXL

___________________________________________
signed (parent or guardian signature if participant is under 18 years of age.)

Player #3
Name__________________________________
Address__________________________________
City__________________ Zip___________________ Phone_____________________
Birthdate____/____/____ Grade_______ (next school year)
I waive and release any and all claims for damages that I may incur as a result of my participation in the LIttle Panther Shootout against Price Laboratory School, NU Booster Club, Inc., the University of Northern Iowa, all sponsors or any employee, volunteer, official or elected official of these organizations for said injuries. I further certify that I have full knowledge of the risks involved in this event, and that I am physically fit to participate.

T-Shirt Size S M L XL XXL

___________________________________________
signed (parent or guardian signature if participant is under 18 years of age.)
Player #4
Name__________________________________
Address_________________________________
City__________________ Zip___________________ Phone__________________
Birthdate____/____/____ Grade________ (next school year)
I waive and release any and all claims for damages that I may incur as a result of my participation in the LIttle Panther Shootout against Price Laboratory School, NU Booster Club, Inc., the University of Northern Iowa, all sponsors or any employee, volunteer, official or elected official of these organizations for said injuries. I further certify that I have full knowledge of the risks involved in this event, and that I am physically fit to participate.

T-Shirt Size S M L XL XXL

___________________________________________
signed (parent or guardian signature if participant is under 18 years of age.)