A.C.T.S Basketball League

A.C.T.S Basketball League

Athlete Registration Form
Athlete Information
Player Name*

First & Last nameHeight/Weight/Age
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
E-mail*
example@example.com
Athlete Basketball Skill Level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Important Notes

$225/Child

Adult Teams- $800/team or $133/Player

Coaches- $50

· Dress appropriately.

· No food or drink in the gym.

· Keep the gym clean.
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
YesNo
Please describe*
If yes, please include if the child has asthma.
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
Format: (000) 000-0000.
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.
YesNo
Confirmation E-mail*
example@example.com
Signature*

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A.C.T.S Basketball League

Release of Liability