Basketball League Registration Form

Athlete Information

Player Name

First NameLast Name

Age

Gender

Other

T-Shirt Size

Parent / Legal Guardian

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

E-mail

example@example.com

Which package will your athlete enroll in?

Basketball skill level

1 is Begginer, 5 is Advanced

Emergency Contact Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

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

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 physician or medical care facility to treat my child.
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

Format: (000) 000-0000.

Additional Comments / Requests

Release of Liability

Although the safety of all sport activities is the primary concern, indoor and outdoor sport activities at 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 Youth Hoops 305 Corp. and the persons in charge.

I have read and agree to the above conditions

Confirmation E-mail

example@example.com

Media Release: *I consent and authorize Youth Hoops 305 Corp to use my child's likeness in any photograph, video or other digital media/social media (“Photos”) in any and all of its publications, including print or web-based publications. * I irrevocably authorize Youth Hoops 305 Corp. to copy, edit, enhance, crop, or otherwise alter any Photo for use in their publications. I also waive any rights for approval or inspection of any Photos. * I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos.

Signature

My Products

Teal

$150.00

Pink

$220.00

Black

$300.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Youth Hoops 305 Registration Form

Release of Liability

My Products

Payment Methods