Basketball Club Registration Form

Athlete Information

Player Name*

First NameLast Name

Player Age

Player Grade

YesNo

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

E-mail*

example@example.com

Basketball skill level*

1 is Begginer, 5 is Advanced

Match RefereeOperate Scoreboard

I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.

Important Notes

· Dress appropriately.

· No food or drink in the gym.

· Keep the gym clean.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

YesNo, I'll pay with cash.

Insurance Carrier

Name of Policy Holder

Subscriver ID/Group Number

Card Number / Card Date

YesNo

Please describe*

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.

Participation Waiver
I, the undersigned parent or legal guardian of the above-named player, hereby give full permission for my child to participate in all practices, games, camps, tournaments, and other events organized by CC Lady Hoopers Basketball Club.

I acknowledge that participation in youth basketball involves physical activity, contact, and the potential for injury or accidents. I voluntarily accept all risks associated with participation and understand that CC Lady Hoopers Basketball Club, its coaches, staff, volunteers, affiliates, and facility partners are not responsible for any injury, illness, property damage, or other losses that may occur during club-related activities.

I certify that my child is in good physical health and is capable of participating in all basketball activities. I agree to notify the club in writing of any medical conditions, allergies, or physical limitations prior to participation.

Medical Authorization
In the event of an injury or emergency involving my child, I authorize CC Lady Hoopers Basketball Club staff or representatives to administer first aid, arrange transportation, and obtain emergency medical treatment on my behalf. I understand that every effort will be made to contact me or the listed emergency contact. I assume full financial responsibility for any medical services rendered.

Photo/Video & Media Release
I grant permission to CC Lady Hoopers Basketball Club to photograph, video record, or otherwise capture my child during practices, games, or team events. These images may be used for promotional and marketing purposes including, but not limited to:

Club website and social media (Instagram, TikTok, Facebook, etc.)
Flyers, banners, or highlight reels
Online or printed newsletters and promotional content
I understand that no compensation will be provided for the use of my child’s likeness, and all media becomes the sole property of CC Lady Hoopers Basketball Club.

Release of Liability & Assumption of Risk
Although the safety and well-being of all players is a top priority, I acknowledge that participation in indoor sports activities—particularly basketball—includes inherent risks such as physical contact, collisions, falls, and other unpredictable events. These risks may result in injury, illness, or in rare cases, death.

I knowingly and voluntarily waive, release, and hold harmless CC Lady Hoopers Basketball Club, its directors, officers, coaches, volunteers, sponsors, facility partners, and representatives from any and all liability, claims, or causes of action arising out of my child’s participation in club activities, whether due to negligence or otherwise.

Acknowledgment
By signing below, I confirm that I have read, understood, and voluntarily agree to the terms of this Participation & Liability Waiver in its entirety. I affirm that I am the parent or legal guardian of the minor named above and have the legal authority to execute this agreement.

YesNo

Confirmation E-mail*

example@example.com

Signature*