Lions Basketball Team Registration

Loberg Athletic Lion's Basketball

Registration
Athlete Information
Player Name*

First NameLast Name
Age
Grade
Current School
Jersey Size (xs, s, m, l, xl)
Top
Jersey Size (xs, s, m, l, xl)
Shorts
Jersey No. Desired (please pick 3)
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
E-mail*
example@example.com
Athlete's Basketball Experience (Please be detailed)
Program Goals / Expectations for Athlete (Please be detailed)
Emergency Contact
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*
Liability Waiver:
The risk of injury to my child from the activities involved with Loberg Athletic LLC, staff members, and facilities is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, I willingly agree to comply with Loberg Athletic LLC stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; Loberg Athletics LLC, directors, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, partnering facilities, and if applicable, owners and lessors of premises used to conduct the event releases, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. I, for myself, my spouse, and my child HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I, the parent/guardian, assert that I have explained to my child: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement. I, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTANDING ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO THESE TERMS.
I have read and agree to the above conditions*

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

Powered by Jotform SignClear

Payment - Deadline is 8/27/24
prevnext( X )
Team Dues (3rd - 8th grade teams)This will cover membership with organization for one full year which includes winter session league, LA Staff assigned coaching, speed/strength nights, and practice facility rental.
$500.00



Club Dues (3rd-8th) Single Session - WinterThis offers the option of playing one session with Loberg Athletics to provide multi sport athletes with flexibility.
$275.00



Club Dues- Single Session (3rd-8th) - Winter Session IIThis offers the option of playing one session with Loberg Athletics to provide multi sport athletes with flexibility.
$275.00



Uniform Dues (3rd-8th grade teams)1 Time Fee
$110.00 Quantity



Team Dues (1st - 2nd grade teams)This will cover membership with organization for one full year which includes fall/winter session league, jersey, LA Staff coaches, speed nights, and practice facility rental.
$275.00



Total

$0.00
I understand the following:

Team dues cover winter session league, practices, speed/agility nights, and coaches (Paid every year, once a year)

A jersey must be purchased seperate from team dues.

One tournament a month ($200 a team) must be split amongst players.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Loberg Athletic Lion's Basketball