Young Panther Registration Form

Young Panther Registration

This form is to register for our Young Panther Program. We offer the program on Saturday's. When you sign-up, you will be informed as the dates come up.
Date Today

MonthDayYear
Date
Young Panther's Name
School Name
Grade 2024-2025 School Year
Date of Birth

MonthDayYear
Date
Age
Gender
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

AAU Basketball Application Information
Parent/Guardian Name
Parent/Guardian Phone Number
Additional Adult Name
Type N/A if not applicable
Addition Adult Phone
type N/A if not applicable

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to Athlete

Parental/Guardian Consent
Training Permission:

I hereby authorize the staff of the LIFE Elite Athletics/ Life Is Me Organization to act according to their best judgment in any emergency requiring medical attention. I hereby waive, and release the location of said training, Life Is Me, LIFE Elite Athletics, Raea Wilson and staff from any and all liability for any injury or illness suffered prior to workout sessions. I have no knowledge of any physical impairment that would affect my child's participation in the basketball tryout. I give my permission for said participant to take part in the LIFE Elite Athletics basketball tryouts.
Name of Doctor

First NameLast Name
Clinic / Hospital
Insurance Carrier
Waiver

I am fully aware that this sport activity may cause accidental injury to athletes. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against the Commission and the Organizing Committee of this event should in any case that the accident, injury, illness or death occurs in the course of any activity held by them.
Photo/Video Permission:

I hereby grant LIFE Is Me/LIFE, LIFE Elite Athletics, its representatives and employees, or anyone authorized by LIFE Is Me/LIFE Elite Athletics, permission to use my likeness and/or the likeness of my child(ren) in a photograph in any and all illustrations, advertising, publications, including website entries, without payment or any other consideration. I understand and agree that these materials, including all negatives and positives, together with the prints, will become the property of LIFE Elite Athletics and will not be returned. I hereby irrevocably authorize LIFE Elite Athletics, its representatives and employees, or anyone authorized by LIFE Elite Athletics, to edit, alter, copy, exhibit, publish or distribute this photograph for the purposes of publicizing LIFE Elite Athletics basketball programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness or the likeness of my child(ren) appears.
Name

First NameLast Name
Date Signed

MonthDayYear
Date
Should be Empty:

Young Panther Registration

AAU Basketball Application Information

Emergency Contact Information

Parental/Guardian Consent