Girls Fall League

Any questions please contact

Coach Shadricka (813) 756-9163

Season Runs mid August - Early October Fundraising is MANDATORY!!!!

Practices will be Tuesday and Thursday from 6:00pm-7:30pm

Ocoee Chaos AAU Girls Basketball Registration Form Please fill out the secure online registration form below for each athlete. The athlete's spot will only be reserved upon receipt of registration. If you have any questions, please feel free to contact us at ocoeechaos@gmail.com

Athlete Information

Athlete's Full Name*

First NameLast Name

School Grade*

Athlete's Age*

Current School Attending*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Full Name*

First NameLast Name

Cell Number

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

YesNo

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities of Ocoee Chaos AAU Girls Basketball Team during the selected session. In exchange for the acceptance of said child’s candidacy by , I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Ocoee Chaos AAU Girls Basketball Team and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of travel to, participating in, or returning from practices, exhibitions, parades or competitions conducted during the season. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. In case of injury to said child, I hereby waive all claims against Ocoee Chaos AAU Girls Basketball Team . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. Furthermore, all images and videos of Ocoee Chaos AAU Girls Basketball Team are the property of Ocoee Chaos AAU Girls Basketball Team and can be used for any promotional consideration. I hereby state that I have carefully read the above waiver. Acceptance and understanding of this agreement are hereby acknowledged.

I have read and agree to the Informed Consent and Acknowledgement.

Please initial*

Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Ocoee Chaos AAU Girls Basketball Team. Director/Coach/Team Parent to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates of the registered sessions. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

I have read and agree to the Medical Release and Authorization.

Please initial*

Parent/Guardian Signature*

Confirmation E-mail*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at ocoeechaos@gmail.com

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