Basketball Team Registration New Players Spring 2023

Registration Form

Basketball Competition Teams

Royal Kings & Queens

52 West Fauna Ct. Mountain House CA 95391

info@royalkings.org

www.royalkings.org

209-319-7290
Athlete Information
Athlete Name*

First NameLast Name
Athlete Phone Number*

Area CodePhone Number
DOB*

MonthDayYear
Date
Age*
Grade*
Team
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Do the athlete have health insurance ?

YesNo
Insurance Carrier
Name of Policy Holder
Insurance Card No.
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
Authorization/Waiver of Liability: I, as participant (or parent or guardian) of the above named participant in the above mentioned program, hereby give approval for my son participation in this basketball training. I assume all risks and hazards incidental to such participation, and hereby waive all claims against this club Royal Kings, and any other personnel involved in any injury or accident while participating in this program. I do hereby waive, release, absolve, indemnify and agree to hold harmless the organization, the organizers, sponsors, supervisors, coaches, participants and the club Royal Kings for any claim arising out of an injury to the above named participant. I also grant permission to managing personnel or other representatives to authorize and obtain medical care should the above participant becomes ill or injured when neither parent or guardian is available to grant authorization for emergency treatment. I also certify that all information on this form is true. I understand that misrepresentation could result in suspension from the program. I have read and understand all information outlined on this form and the Parent Information Sheet. I agree to adhere to all rules of the league and all terms of all information regarding this league. Covid-19 saftey protocol is strictly followed per AAU rules & regulation. No pay No Play policy.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
Signature*

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My Products
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New Player Full Payment$575.00
$500 + $75 uniform cost 3 Months Season (March, April, May)

New Player Payment Installment #1$275.00
$200 + $75 uniform cost (First Payment) **DUE UPON REGISTRATION**

New Player Payment Installment #2$300.00
$300 (Second Payment) **DUE APRIL 1st**

Total $0.00
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