Basketball League Registration Form

Youth Hoops 305 Registration Form
Athlete Information
Player Name*

First NameLast Name
Age
Gender

FMOther
T-Shirt Size

XSSMLXL
Parent / Legal Guardian*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
E-mail*
example@example.com
Which package will your athlete enroll in?

TealPinkBlackDiamond
Basketball skill level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone 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 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
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*

YesNo
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.

YesNo
Signature*

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My Products

Teal

$150.00

Pink

$220.00

Black

$300.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

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Youth Hoops 305 Registration Form

Release of Liability

Payment Methods