Basketball League Registration Form

Athlete Information

Player Name*

First NameLast Name

Player Gender*

MaleFemale

Grade*

Guardian / Parents Names*

First NameLast Name

Phone*

Area CodePhone Number

E-mail*

Basketball Skill Level*

	1	2	3	4	5

1 is Beginner , 5 is Advanced

Emergency Contact & Health Insurance 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*

Name of Physician / Emergency Medical Care Facility

Phone Number

Area CodePhone Number

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.

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Youth Sport Center and the persons in charge.

I have read and agree to the above conditions*

YesNo

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 t3elitetraining@gmail.com