The Boutique Foundation 3v3 Basketball League Registration Form

Youth Basketball - Creme de la Creme 3v3 Winter League 2023 - Registration Form

(age 13 and older)

J. Clarke Richardson Collegiate - 1355 Harwood Ave N, Ajax, ON L1T 4G8

boutiquebasketballinc.com

Athlete Information

Player Name*

First NameLast Name

Age?*

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Phone #*

Area CodePhone Number

E-mail*

Player's E-mail*

example@example.com

Basketball skill level*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Important Notes

· Dress appropriately. - Please be in proper athletic attire (Reversible Jersey, Shorts, Basketball Shoes)

· 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.

· Fee: $175 per participant. Please send all payments to theboutiquefoundation@gmail.com

· Season Includes 7 games plus playoffs and a reversible jersey.

Emergency Contact Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

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

YesNo

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

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

Informed Consent/General Release-Youth Basketball Participants

PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR AGREEMENT.
NOTE: THIS FORM INCLUDES A RELEASE OF LIABILITY.

Since participation in youth sports activities can be dangerous, Boutique Basketball Inc. and The Boutique Foundation requires that all participants (and their adult parent(s) or guardians) to assume all risks associated with youth basketball training by signing this general release.

For and in consideration of my child being permitted to participate in Boutique Basketball's Elite Training & Development, I hereby voluntarily release, discharge, waive and relinquish any and all claims or actions for damages for personal injury, permanent disability, death, or property damage which I or my child may have, or which may here after accrue to me or my child, as a result of my participation in youth basketball activities during play and while I am at the facility while others play or for any other reason. This release is intended to discharge, in advance, Boutique Basketball Inc., it’s affiliates, officers, employees and agents, and the owners and maintainers of any facility used for basketball training or activities, from any and all liability arising out of or connected in any way with my child’s participation

in basketball camps/clinic activities, even though that liability may arise out of negligence or carelessness on the part of Boutique Basketball Inc, its affiliates, officers, agents or employees, or the owners or maintainers of any facility used by Boutique Basketball Inc. or The Boutique Foundation for basketball training or activities.

I further understand that serious accidents occasionally occur during youth basketball activities, and that participants occasionally sustain serious personal injuries, death or property damage as a consequence thereof. Knowing the risks, I have voluntarily applied for my child to participate in the activity and thereby agree to assume those risks to release and hold harmless Boutique Basketball Inc, its affiliates, officers, employees or agents, or the owners or maintainers of any facility used by Boutique Basketball Inc for basketball training or activities, who (through negligence or carelessness) might otherwise be liable to me or to my child (or my heirs or assigns) for damages.

I further understand and agree that this release, discharge, waiver, and assumption of risk is to be binding on my and my child’s heirs, executors, administrators, and assigns.

I further agree to indemnify and to hold harmless Boutique Basketball Inc., its affiliates, officers, employees and agents, or the owners or maintainers of any facility used by the Boutique Basketball Inc. for basketball training or activities, for any loss, liability damage, cost or expense which may incur as a result of any injury or property damage I or my child may sustain while participating in the activity.

I agree to comply with the program’s stated and customary terms and conditions for participation according to Boutique Basketball Inc. If I observe any significant change with regards to my child’s readiness for participation in the program, I will remove my child from the program immediately.

I have read this Informed Consent/General Release, fully understanding its terms, that I give up substantial rights by signing it, and sign it voluntarily.

I have read and agree to the above conditions - Waiver of Liability Signature -*

I accept the terms outlined in the agreement above.

Confirmation E-mail*

Signature*

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 theboutiquefoundation@gmail.com.