New Player Registration Form 22

RISE Basketball School Registration
You will need to fill out one registration per child. Once you have completed the registration you can start a new registration form for the next child. * This registration and it's consent forms are good for 1 year from the date first signed*
CHILD INFORMATION:
Child Name *

First Name Last Name
Grade: *
Birth Date *

Month Day Year
Male/Female *
Service Interested In

Club Team Private / Semi-Private Training Camps Court Rentals Other
Basketball Playing Experience

Never Played Beginner - Some team playing experience (I9, YMCA) Intermediate - 1+ years of club team playing experience (AAU) Advanced - Multiple years of club team playing experience
PARENT / LEGAL GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Emergency Contact: *

First Name Last Name
Phone Number *

Area Code Phone Number
Disclaimer / Consent
I certify that to the best of my knowledge that I, or my child, is in good health and is capable of participating in RISE Basketball School. I, as the parent or guardian of the player listed on this form, hereby for myself, my heirs, executors, and assigns do waive and release any and all claims and rights for damages , liability, actions, and causes of actions whatsoever, arising out of or related to any loss, damages, or injury, including death, that may be sustained while participating in RISE Basketball School. I agree to indemnify and hold harmless RISE Basketball School and it's officers and board of directors, referees, coaches, and all other volunteers for any and all legal action arising from my, or my child's participation in the recreational, competitive, indoor and futsal leagues; in addition to training conducted by RISE Basketball School' staff. I, the undersigned, and dully aware of the risks and hazards inherent upon participating in said event. I hereby certify that I have read and understand this consent and release form.
Signature *

Clear
Date *

Month Day Year
UNIFORM INFORMATION
Youth Jersey *
Youth Shorts *
Adult Shirt *
Adult Jersey *
MEDICAL RELEASE FORM
Physician Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Date of last Tetanus Booster

Month Day Year
Medical Concerns(Allergies, Allergies to Medicine, Medical Problems)
RELEASE FOR USE OF IMAGES/VIDEO
I hereby give my consent to Full Circle Futbol, LLC to photograph, film, videotape and then use, reproduce, and publish said images of me and/ or my child/ children.
I have read and agree to the above conditions. *

Yes No
Parent Name *

First Name Last Name
Child Name *

First Name Last Name
I agree that photographs/negatives, film, or videotapes thereof shall constitute the sole property of [RISE Basketball School, LLC], with full right of disposition in any manner whatsoever, including the right to publish all [RISE Basketball School, LLC] advertisement. I hereby release [RISE Basketball School, LLC] and his/her legal representatives and assigns from any and all claims whatsoever in connection with the use, reproduction, publication of the images thereof.
Signature *

Clear
Date *

Month Day Year
Signature for minor child *

Clear
Should be Empty:

RISE Basketball School Registration

CHILD INFORMATION:

PARENT / LEGAL GUARDIAN INFORMATION:

Disclaimer / Consent

UNIFORM INFORMATION

MEDICAL RELEASE FORM

RELEASE FOR USE OF IMAGES/VIDEO