Basketball League Registration Form

NSK Girls Basketball Club Registration
Athlete Information
Welcome to Nevada Sterling Knights Girls Youth Basketball
Player Name*

First NameLast Name
Are you over 18 ?*

YesNoOther
Player Date Of Birth
Player Age
Player Grade
School Currently Enrolled
Guardian / Parents Names*

First NameLast Name
Guardian / Parents Names

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
Can we Text you at the above cell number?

YesNo
E-mail*
example@example.com
Basketball skill level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Player Position

Point GuardShooting GuardCenterSmall FowardPower FowardDon't Know
Interested In Tournament participation?

YesNoDon't Know
Uniform Size (Reversible Included with Fees)

Youth SmallYouth MedYouth LargeAdult SmallAdult MedAdult LargeAdult XL
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Do you have health insurance ?

YesNo, I'll pay with cash.
Insurance Carrier
Name of Policy Holder
Subscriver ID/Group Number
Card Number / Card Date
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
Release of Liability

Although the safety of all sport activities is the primary concern, indoor 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 the Sport Center and the persons in charge.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
example@example.com
Signature*

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Check List:

The following items are required to be filled out before your child can participate in any event/practices.

1: Club Registration ( this form)

2: Liability and Release form. ( On website home page)

3: Media Release Form ( On website home page)

4: Registration fees.
Should be Empty:

NSK Girls Basketball Club Registration

Welcome to Nevada Sterling Knights Girls Youth Basketball

Release of Liability