Univeristy City Wildcats Registration Form

University City Wildcats
2025 Registration Form

Please fill out the secure online registration form below for each athlete. If you have any questions, please feel free to contact us at DemiteraParham@gmail.com

Athlete Information

Full Name*

First NameLast Name

Age*

Full Name

First NameLast Name

Age

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Jersey Information

Athlete 1 T-Shirt/Jersey Top Size*

Parent/Guardian Information

Parent Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

example@example.com

Emergency Contact

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Medical Information

Does the athlete have any allergies, chronic illness, or medical conditions that would limit high-intensity activity?*

YesNo

Please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

YesNo

Please explain any instructions.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, or x-ray examination, for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the University City Wildcats Director/Coach/Volunteer to provide the needed emergency treatment prior to the child’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child(children), in my absence.

I have read and agree to the Medical Release and Authorization*

Please Initial

Media Consent

University City Wildcats has my permission to take, use, and reproduce photos, videos, and other media of myself and my child in any legal manner to promote the organization. UCW may use media in print publications, websites, social networking sites, and other online platforms. I also understand that by signing this release, I waive any/all present or future compensation rights to using any/all media material(s).

I have read and agree to the Media Consent*

Please Initial

Program Policies and Terms

Registration fees:

The cost of registration is $150 and is due when submitting the registration form. The registration fee must be paid in full before registration can be finalized.

Refunds:

University City Wildcats will not provide refunds under any circumstances, regardless of the reason for non-participation.

If the athlete is unable to participate during the current season, please send an email notification to University City Wildcats (Demiteraparham@gmail.com) to request a withdrawal. If the athlete withdraws from the program within 28 days of the registration form submittal, the registration fees may be applied to the session immediately following the current one. This exception may be granted as a one-time courtesy if requested in writing via email.

There are NO REFUNDS or CREDITS for the program fee if an athlete is removed from the University City Wildcats program due to disciplinary conduct before the end of the session.

I have read and agree to the Program Policies and Terms*

Please Initial

Informed Consent

I certify that I consent to have my child (children) participate in the University City Wildcats basketball program. I agree to release, absolve, and hold harmless University City Wildcats, its coaches, volunteers, and all its respective representatives from any/all liability for injuries.

I acknowledge and understand the risk of injury when participating in athletics. I know that the athlete(s) will be supervised and instructed to reduce the risk of injury to themselves and others. However, I acknowledge and understand that neither the coach(s), volunteers, nor the University City Wildcats Organization can eliminate the risk of injury in sports. Injuries may and do occur. Sports injuries can be severe and, in some cases, may result in permanent disability or even death.

I freely, knowingly, and willfully accept and assume the risk of injury that might occur from participating in sports.

I have read and agree to the Informed Consent*

Please Initial

Payment Authorization

1. I understand that payment is required before registration can be finalized.

2. By submitting this registration form I authorize University City Wildcats to charge my credit card below for the items listed.

Full Name*

First NameLast Name

Confirmation E-mail*

example@example.com

Registration*

Registration $150.00

# of Registrations

Enter coupon

Total $0.00

Credit Card