SIBL/CT FLYERS

SIBL/CT FLYERS AAU Basketball

BASKETBALL LEAGUE
Registration Form
Name*

Player First NameLast Name
Address*

Address

Street Address Line 2

CityState / Province

Zip
Birth date*

MonthDayYear
Date
Age*
Grade*
School
Medical Conditions*
Fathers Name
Phone Number*
Please enter a valid phone number.
Mothers Name
Phone Number
Please enter a valid phone number.
Medical Release Information
To induce the SIBL/CT FLYERS Program and its representatives to accept registration and permit participation by the above named minor. I hereby give my permission, consent, and agree to release, indemnify, and hold harmless the SIBL/CT FLYERS Program Basketball Program, its officers, coaches, and representatives from any claims arising from any injury and/or Covid 19 to the above-named minor participant. If minor becomes sick, please keep them home! Consent for medical treatment as the parent or legal guardian of the above-mentioned player. I hereby give my consent for emergency care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent.
Parent Signature*

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Emergency Contact (other than above):
Name*
Phone Number*
Please enter a valid phone number.
Parent Signature: * by signing you are making yourself liable for the fee associated with participation within SIBL/CT FLYERS AAU Program
Parent Signature*

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Liability Waiver:

I, herein release from liability and hold harmless SIBLYOUTH CT LLC Basketball, hereinafter SIBLYOUTH CT, CT FLYERS, and its DIRECTORS, PROGRAM MANAGERS, COACHES, TRAINERS and THEIR family, from any liability of any kind, related to or arising out of any basketball game organized by SIBLYOUTH CT OR AFFILIATES, that I attend or participate in, including, but not limited to, allegedly contracting Covid-19 at said game, acts of neglect, intentional acts or any other acts of any kind.

I also similarly herein release from said liability and hold harmless the owner or proprietor of ANY basketball court or facility, where said game is played. Should I or anyone associated with me in any way commence any legal action against SIBL YOUTH CT, I agree to pay for any and all legal costs that SIBL YOUTH CT LLC may incur as a result of any action taken by me or my associates. This release is for any and all liability for personal injuries and illness, including death and alleged contraction of Covid-19, plus any property loss or damage occasioned by, or in connection with, any activity or accommodations before, during or after any said basketball game. This is a legally binding document, and by herein legibly dating, and printing & signing my name on this form, I knowingly am waiving certain rights, and if I do not understand any aspect of this document, my signature indicates that, prior to affixing said signature, I have sought and received the assistance of a state licensed attorney. If said person is under 18 years of age, his/her name should still be printed, but his/her parent or legal guardian must also print his/her name and affix his/her signature. Player and Parent/legal guardian, last/first names & signature
Names & Signature*

Prefixfirst nameLast name printedSuffix
Date*

MonthDayYear
Date
Signature*

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PARENT Names & Signature*

Prefixfirst nameLast name printedSuffix
Date*

MonthDayYear
Date
Signature*

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Randall Cheeseborough Scan to pay $RCSIBL
Payments

Payments can be made on-time or into split payments, first payment on this form.

PAYMENTS

First Payment Only (1/5s)Full amount split into 5 payments (First payment)

$150.00 Quantity

Full Payment Entire amount in one payment.

$750.00 Quantity

Cash App NOTE: Must send funds via CashApp after sending this registration form.

$ Free Quantity

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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SIBL/CT FLYERS AAU Basketball

Registration Form

Medical Release Information

Payments