Montreal United Spring/Summer Basketball program registration form

Basketball Program - Registration Form (age 13 and older)

info@montrealunited.ca
Athlete Information
Player Name *

First Name Last Name
Are you over 18 ? *

Yes No
Date of Birth
Guardian / Parents Names *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Home Phone *
Cell Phone
E-mail *
example@example.com
Basketball skill level *

1

2

3

4

5

1 is Begginer, 5 is Advanced
Interested in Volunteering in other activities when not playing?

Operate Scoreboard Selling T-shirts etc Other
Emergency Contact & Health Insurance Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *
Do you have any allergies, chronic illness, or medical conditions that would limit high level activity? If yes please describe below *

Yes No
Please describe *
Release of Liability Although the safety of all sports activities is the primary concern, indoor sports activities at Cote St. Luc gym may cause injuries. I expressly assume the risk of injury, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Cote St. Luc gym; Montreal United and any/all persons associated/in charge.
I have read and agree to the above conditions *

Yes No
Confirmation E-mail *
example@example.com
Signature *

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform