Synergy Basketball League Registration Form

Synergy Athletics - Basketball Tournament League Registration
Athlete Information
Player Name

First NameLast Name
Guardian / Parents Names

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/Cell Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
E-mail
example@example.com
Basketball skill level

1

2

3

4

5

1 is Beginner, 5 is Advanced
Male/Female
Shirt Size
Player's Current Grade
Player's Birthday
League organizers will form teams based on gender, age, grade, and skill level. Please tell us a little about your player.
Emergency Contact Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Do you have health insurance ?
Insurance Carrier (optional)
Name of Policy Holder (optional)
Subscriber ID/Group Number (optional)
Card Number / Card Date (optional)
Do you have any allergies, chronic illness, or medical conditions that would limit high level activity?
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 (optional)
Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (optional)
Format: (000) 000-0000.
Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities with Synergy Athletics pracitces and events 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 Synergy Athletics and the persons in charge.
I have read and agree to the above conditions
Once all registrations have been received by 2/2/24, players will be evaluated and placed on appropriate teams based on age, grade, sex, skill level (to the best of our ability). Our goal is to provide fundamental instruction while also promoting a competitive atmosphere. If there is not adequate registrants for certain levels, we will let you know asap and keep your information for further teams/leagues opportunities. When teams are confirmed, registration fees will be due at parent/player meeting in February (TBA). I have read and understand
Interested in Volunteering ? (optional)
Confirmation E-mail
example@example.com
Signature
Should be Empty:

Synergy Athletics - Basketball Tournament League Registration

Release of Liability