Elite Boys and Girls Club Registration Form

Elite Boys and Girls Club - Texas Kings Basketball - Registration Form (age 10and older)
Athlete Information
Player Name

First Name Last Name
Are you over 18 ? *

Yes No
Guardian / Parent Name *

First Name Last Name
Guardian / Parent Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Home Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
E-mail *

Basketball skill level *

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering while your team not playing?

Match Referee Operate Scoreboard
Important Notes · Dress appropriately. · No food or drink in the gym. · Keep the gym clean. · The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.
Emergency Contact & Health Insurance Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Do you have health insurance ?

Yes No
Insurance Carrier
Name of Policy Holder
Subscriber ID/Group Number
Card Number / Card Date
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No
Please describe *
Parental Permission For Emergency Treatment In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to: I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Type a question
Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Youth Sport Center and the persons in charge.
I have read and agree to the above conditions *

Yes No
Confirmation E-mail *
Signature *

Clear
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 info@eliteboysandgirlsclub.org
Parental Photo Consent Form for Children/Minors
We recognize the need to ensure the welfare and safety of all young people
taking part in any activity associated with our organization.
In accordance with our child protection policy we will not permit photographs,
video or other images of young people to be taken without the consent of the
parents/carers and children. As your child will be taking part in the event
specified above, we would like to ask for your consent to take
photographs/videos of the event or activity that may contain images of your
child. It is likely that these images may be used as
• a record of the activity or the event
• in a written evaluation of the event that will be viewed by the public
• publicity material for further activities or events on
leaflets/websites/magazines
• illustrations of the activities or events in published articles
• future grant applications

We will take all steps to ensure these images are used solely for the purposes
they are intended. If you become aware that these images are being used
inappropriately you should inform us immediately.

I consent to having my child photographed or recorded for this event contd.

Child's Name:blanks
Parent or Legal Guardian's Name: blank
Parent or Legal Guardian's Signature and Date: Signature Date

Should be Empty:

Parental Photo Consent Form for Children/Minors