JR. NBA - 6 Week - Basketball League Registration Form

Athlete Information

Player Name*

First NameLast Name

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Basketball skill level*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering while your team not playing?

Match Referee (Paid Position)Operate Scoreboard (Parent Recommended)Parent CoachingBookkeeper (Parent Recommended)

I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level. Please list grade level below.

Important Notes

· Dress appropriately.

· No Cursing or Fighting with referee will be escorted from gym and premises.

· Keep the gym and benches clean respectfully for other team and parents.

· The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.

· Fee: $10 per participant. All the money will be used for prizes and buying food drink for end of season small party must be turned in on or before week 4!

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*

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

Although the safety of all sport activities is the primary concern, indoor sport activities with Big Blessings Sports Foundation and Marion Community Schools, 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 Big Blessings Sports Foundation, Marion Community Schools, 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 bigblessingsports@gmail.com. Be sure before you submit your form and Select Payment Opitons in new tab. Thank You!

1st thru 9th: Boy's & Girl's - 4 Payments for ($25) link:

https://buy.stripe.com/eVa2bPcscaUwbgQ3cG

1st thru 9th Grade: Boy's & Girl's - 2 Payments for ($50)

https://buy.stripe.com/14k7w93VGaUwbgQ28D