Hapoel USA Registration Form

Player Name*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Shirt Size*

We recommend selecting one size up

Jersey Number*

Pick your favorite number

Parent Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Insurance Information*

Welcome Packet - REQUIRED PER PLAYER

$120 - One time cost Includes; Basketball, Bag, Reversible Set, Practice Jersey, Kippah, Bracelet and a Water Bottle

Referring Coach*

Payment Methods

Additional payment options available on demand. Please contact us for more information

Payment due upon enrollment. Fees are NON-Refundable

***Important Disclosures***

PARENT PERMISSION FORM, LIABILITY WAIVER AND RELEASE, AND AUTHORIZATION FOR MEDICAL/DENTAL TREATMENT
I understand that participation in Hapoel USA basketball programs involves risk and dangers of serious and permanent bodily injury and death. I hereby release, hold harmless, discharge and agree not to sue Daniel Tamir and/or Hapoel USA, all their affiliates and DBA, all directors, officers, employees, coaches, officials, volunteers, owners/lessors of premises for and from all liability from my participation in and with these and any other related travel, lodging, social and recreational activities. I also understand Hapoel USA and/or Daniel Tamir retains the right to use for publicity and advertising, photographs and video taken of the participants. 
I have given my child/children permission to participate in Hapoel USA and/or Daniel Tamir Basketball programs, and I certify that they are in good health, have been cleared by a physician and can take part in all physical activities not limited to, but including training, practices, and games. I am aware that my child/children may become injured. If an injury occurs, I authorize the staff members to take any action and use the emergency service available at the nearest hospital if necessary. I understand my personal insurance will be used in this case. In case of an emergency, I authorize the personnel to take action. 


I, the undersigned, the parent and/or legal guardian of the Player as mentioned above, hereby grant permission for Hapoel USA and/or Daniel Tamir, its employees and coaches to authorize medical or dental treatment for the child/children by any available and qualified physician/dentist or other trained medical personnel. In addition, this permission extends to and includes authorization for emergency treatments, procedures, and surgeries for the player. Furthermore, on-going medical treatment is authorized until such time as the undersigned shall dismiss these physicians/medical personnel in writing and have engaged another qualified physician. This permission and authorization includes admission to a hospital or medical facility if the attending physician deems it necessary. 

In consideration for being permitted by the above program to participate in the above activity, I herby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter occur to me, as a result of participation in said activity. This release is intended to discharge in advance the above program (its officers, employees, volunteers, and agents), Hapoel USA Basketball training from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to identify and hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which they may occur as the result of any injury, property damage, or death that I sustain while participating in said activity. 
PARENTAL CONSENT (Review and sign by parental/guardian in below box):
I hereby additionally consent that my son/daughter may participate in the above activity and I hereby execute the above AGREEMENT, WAIVER, AND RELEASE on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may occur as a result of the any injury, property damage, or death that said minor may sustain while participating in said activity. 
I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the above program Hapoel USA Basketball and I sign it of my free will. 
I further understand that no medical insurance is provided and that no refunds will be given unless activities are changed or cancelled by Hapoel USA INC. 

I further understand that photographs and video may be taken during the course of the said activity and that these photographs and video may be used for Hapoel USA. I HAVE READ AND UNDERSTAND THIS RELEASE.

Policies and Waivers

Behavior Policy
Hapoel USA reserves the right to dismiss students whose behavior proves disruptive to other participants. In such cases a consultation will be held with all relevant parties before any action is taken. Refunds may not be offered in such cases.

Liability Waiver
I hereby grant permission for my child/children to participate in Hapoel USA classes and/or programs. I am fully aware of the risks and hazards connected with my child's participation in any activity through Hapoel, and hereby allow my child to voluntarily participate in such activity, knowing that the activity may be hazardous to my child or to his or her property.

Photo Release
I grant Hapoel USA permission to take video, photographs and/or other images of me or my child's involvement in activities provided by Hapoel USA for promotional purposes without compensation to me or my child. We will always try notify you if we use any pictures, video and so on taken from any of our activities.

Refunds
Refunds will only be granted if in writing (email) BEFORE the first class of the month. No refunds will be given out after the second class. Tuition will not be refunded if your child misses a class, leaves a class or is asked to leave due to disruptive behavior. There is a $20 refund processing fee for all requested refunds.

Cancellations
An individual class may be canceled due to weather, low enrollment or unforeseen circumstances. Cancellations will be brought to the attention of all participants as soon as possible and a make-up class will be arranged if possible. Notification for cancelled classes and makeups will be emailed. In the event we cancel the session/season due to low enrollment, your money will be credited or refunded.

Parent/Guardian Signature*

My Products*

Grant HS - GIRLS(Sundays 1:00-2:00pm). Price mentioned is final and per season (October-December) Dates - 10/29, 11/05, 11/12, 11/19, 11/26, 12/03, 12/10, 12/17 Registration fees are final and non-refundable

$250.00 Quantity

Grant HS - 4-5 years old 4 & 5 Years old (Sundays 12:00-1:00pm). Dates of activity- 10/29, 11/05, 11/12, 11/19, 11/26, 12/03, 12/10, 12/17 Price includes a one-time registration fee Price mentioned is final and per season. Registration fees are NON-Refundable

$250.00 Quantity

Valley Village (Grant HS) - 1st-2nd Grade Product Image

Valley Village (Grant HS) - 1st-2nd Grade1st-2nd Grade (Mondays and Wednesdays 6-7pm) Price mentioned is final and per season (October-December). Registration fees are NON-Refundable based on our refund policy below.

$350.00 Quantity

Valley Village (Grant HS) - 3th-5th Grade Product Image

Valley Village (Grant HS) - 3th-5th Grade3rd-5th Grade (Mondays, Wednesdays 6-7pm plus Sunday 3-4pm Game) Price mentioned is final and per season (October-December). Registration fees are NON-Refundable based on our refund policy below.

$480.00 Quantity

Valley Village (Grant HS) - 8th-9th Grade Product Image

Valley Village (Grant HS) - 8th-9th Grade8th-9th Grade (Mondays, Wednesdays 7-8pm plus Sunday 2-3pm Game) Price mentioned is final and per season (October-December). Registration fees are NON-Refundable based on our refund policy below.

$480.00 Quantity

Valley Village (East Valley HS) - 6th-7th Grade Product Image

Valley Village (East Valley HS) - 6th-7th Grade7th-8th Grade (Mondays, Wednesdays 7-8pm plus Sunday 4-5pm Game) Price mentioned is final and per season (October-December). Registration fees are NON-Refundable based on our refund policy below.

$480.00 Quantity

Total

$0.00

Credit Card

Player Registration Form

Credit Card