Revolution Basketball Fall Ball Registration Form.

Revolution Basketball Fall Ball Registration Form.
Athlete Information
Player Name*

First NameLast Name
School Name and Grade

School NameGrade
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
E-mail*
example@example.com
Emergency Contact
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

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.
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.
I have read and agree to the above conditions*

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

Clear
Should be Empty: