Me vs Me Basketball Registration Form

Me vs Me Basketball Registration Form
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 Phone*
Cell Phone
E-mail*
example@example.com
Age
Grade
Jersey Size
Type in the size needed for player jersey.
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

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

YesNo
Insurance Carrier
Name of Policy Holder
Subscriber ID/Group Number
Card Number / Card Date
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
Assumption of Risk and Waiver of Liability

I acknowledge that while safety is the primary concern, participation in indoor sports activities at the sport facilities carries inherent risks that may result in injury, illness, or death. By participating, I expressly assume all associated risks and agree to waive any right to pursue claims against Sport Center or its staff for incidents arising from these activities.
I have read and agree to the above conditions*

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

Clear

My Products

Fall Tryout Fee Tuesday 9/9 and Thursday 9/11 @ Irene E Feldkirchner Elementary - 105 Andrew Street Green Brook NJ. Middle School 6:30-7:30PM. High school 7:30-8:30PM

$25.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

Should be Empty:

Me vs Me Basketball Registration Form

Assumption of Risk and Waiver of Liability

Payment Methods