CBC - Membership Form

Colorado Basketball Club
Membership Registration Form

Please fill out the secure online registration form below for each athlete. Following submission, you will receive a confirmation email. If you have any questions, please feel free to contact us at info@coloradobasketballclub.com.

Athlete Information

Athlete's Full Legal Name*

First NameLast Name

Athlete's Nickname

Athlete's Birthdate*

MonthDayYear

Athlete's Age*

Player Cell Phone Number

Player Email

Current School Grade*

Current Middle School (attending or will attend)*

Player's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Uniform Information

Women's Jersey Top Size*

Women's Shorts Size*

Preferred Jersey Number - list 3*

Legal Basketball Numbers between 0-5

T-Shirt Size*

Parent/Guardian Information

Mother's Name*

First NameLast Name

Cell Number*

Area CodePhone Number

E-mail*

Father's Name*

First NameLast Name

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Please describe.*

Release of Liability for Minor Participant

I, as the parent / guardian represent and warrant that (my minor child is in a state of health which will allow participation in this physically demanding activity and is being allowed to participate in the Colorado Basketball Club program, related events and activities.

The undersigned acknowledges and agrees that:

I am fully aware that the risk of injury to my child from the activities involved in these programs 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 RELEASEES (defined below) OR OTHERWISE, I assume full responsibility for my child’s participation; and,

I willingly agree to comply with the program’s 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 notify the coaches, remove my child from the participation and bring such attention of the nearest official immediately; and,

I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE Colorado Basketball Club, its directors, officers and all other participants, coaches, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct any event (collectively, the “Releasees”), 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 RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees 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 hereby fully and forever waive, release, discharge and covenant not to sue Colorado Basketball Club, each Releasee, and all league sponsors from all liability to my minor child, myself, our personal representatives, heirs, assigns, executors and successors for any and all loss(es), damage(s) and any and all claims or demands therefore, on account of injury to my child, her property or resultant death, whether caused by the active or passive negligence of all or any of the Releasees or otherwise, in connection with any injury or damages incurred at said league, or any traveling team events within the United States. This also includes any injury sustained going to and from said events. I also understand that I must provide the primary medical insurance in the event coverage is necessary.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Please initial*

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Colorado Basketball Club Director/Coach/Team Parent to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates of the registered sessions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. I have read and agree to the Medical Release and Authorization.

Please initial*

Do you have health insurance*

YesNo

I will complete the Medical Release Form with pertinent insurance information

Please initial*

Release Form for Published Information, Media Pictures & Video

I, the undersigned, do hereby consent and agree that Colorado Basketball Club, its employees, or agents (collectively, "CBC") have the right to take photographs, videotape, or digital recordings of me beginning on and ending on notification to CBC, to use these in any and all media, now or hereafter known, exclusively for the purpose of promoting my basketball skills. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. The photos and accompanying information may include, but is not limited to: individual pictures, team pictures, tournament pictures, practice pictures, video, player name and attending high school.

I do hereby grant permission to CBC to publish photo or personal information and release to CBC all rights to exhibit this work in print and electronic form publicly or privately. Published information will appear, among other places, on the CBC website, and I therefore waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial incentives, payments or obligations for the use of published information, media pictures or video recordings.

Furthermore, all images and videos of Colorado Basketball Club are the property of Colorado Basketball Club and can be used for any promotional consideration.

By signing below, participant's parent or guardian indicates that he or she has read and understood the foregoing statement and by signing intentionally and voluntarily agrees to its terms.

Please initial*

Code of Conduct and Travel Logistics

Any athlete and parent/guardian and/or guarantor placed on an Colorado Basketball team must agree to our FULL Code of Conduct Agreement. This must be completed prior to the athlete being fully accepted into the program.

CBC CODE OF CONDUCT

Athletes are not to give out any personal information to any person not affiliated with the Colorado Basketball Club.

Athletes are expected to maintain the high expectations of attitude and proper personal conduct during team travel and while wearing the CBC uniform. They must remember they are representing the Colorado Basketball Club at all times.
Athletes must avoid incidents which could be interpreted as bringing discredit to the CBC program. Should there be a circumstance beyond the athlete’s control, she must immediately report the incident to the coach.
Athletes will be prompt and attend all authorized events.
Athletes will be expected follow the dress code for travel tournaments as stated in the travel packet on the travel sheet. No short shorts allowed.
For national travel events, athletes will travel with their parents or parents must arrange a chaperone.
All Athletes must stay at the team hotel unless previous permission is granted

NATIONAL TRAVEL TEAM LOGISTICS:

GAME PREPARATION: Players/Parents should prepare to be at the gym 30 minutes prior to game time. Have uniform, shoes, basketballs, etc.

TRANSPORTATION: Players will travelwith parents.

DINING/EATING: Players are responsible for paying for their meals. This is not included in the tournament price.

PARENT RESPONSIBILITY:

Enjoy the games and watch your daughter play
Please do not contact coaches regarding logistics. We will get any necessary information to parents.
Shoud a concern arise, a meeting can be requested to meet with coaches 24 hours after the tournament completion.

I have read and agree to Code of Conduct and Travel Logistics

.

Please initial*

Program Policies and Terms

A completed credit card authorization form must be kept on file with CBC. This will be provided at the time of team selections.

If the named athlete is placed on a team for either season and player accepts, payment for the full program/season fee is deemed due and owing to Colorado Basketball Club and fully earned by Colorado Basketball Club upon the athlete's acceptance into the Colorado Basketball Club program.

If the named athlete is placed on an Colorado Basketball Club team and upon acceptance of the athlete, a parent/guardian and/or guarantor must agree to our FULL Code of Conduct Agreement. This must be completed prior to the athlete being fully accepted into the program.

Any athlete who voluntarily leaves the program prior to the end of the season will be responsible for immediate payment of any balance due on their account, all incurred airline and travel expenses plus a $500.00 termination fee.

There are NO REFUNDS or CREDITS for the program fee if an athlete is removed from an Colorado Basketball Club team due to disciplinary conduct prior to the end of the season and will be responsible for immediate payment of any remaining balance due on their account, all incurred airline and travel expenses plus a $500.00 termination fee.

All parents and coaches will adhere to the 24 hour rule. This policy is in reference to the "cooling off period" and states that if a parent wants to talk with a coach about their child, they must wait 24 hours after the game. If it is during a tournament they must wait until after the completion of the tournament.

Confirmation

By entering the information below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

Parent/Guardian Full Name*

First NameLast Name

Parent/Guardian Signature*

Confirmation E-mail*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at info@coloradobasketballclub.com