Clone of Harlem 7/19

Tournament Entry Form

Welcome to Street 2 Street's Basketball Tournament Sign-up Page.

Please have each player on your team fill out this registration form. Each team can have 3 or 4 players.

There are TWO age divisions, 11-14, and 15-16. If you have a player on your team who is 15 or older, you must play in the 15-16 division.

Teams play a minimum of two games. Your first loss moves you to the loser's bracket. If you lose a second time, you are eliminated from the tournament.

STUDENTS MUST UPLOAD OR BRING STUDENT OR STATE ID TO VERIFY AGE!!

Athlete Information

Player Name*

First NameLast Name

Player Date of Birth*

Date

Parent / Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Grade*

School*

Name of School*

GPA*

Upload a Student ID/ NY State ID*

Browse Files

Screenshot or Picture

Cell Phone*

Format: (000) 000-0000.

Parent / Guardian Email*

Instagram Handle

Division*

Team Name*

Tournament Date/Location*

Have you participated in Street2Street before?*

How many events have you participated in?*

What year did you first participate in Street2Street?*

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

Do you have health insurance ?*

YesNo, I understand that I may not be allowed to participate in the tournament with Street 2 Street, Inc. without medical insurance.

Insurance Carrier

Name of Policy Holder

Subscriver ID/Group Number

Card Number / Card Date

Does you have any allergies, chronic illness, or medical conditions that would limit high level activity?*

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.

Release of Liability

PLEASE READ BEFORE SIGNING

The undersigned (herein “Participant,” listed above) wishes to participate in a Street 2 Street Basketball program (herein “Activity”) wherein the “Activity” is sponsored by Street 2 Street, a charitable, non-profit organization.

Street 2 Street and the undersigned agree that the Activity poses risks including the following specific risks: Normal risks associated with participating in basketball activities including sports related injuries.

For and in consideration of Street 2 Street allowing the Participant to participate in the Activity and other good and valuable consideration, Participant and the Participant’s personal representatives, assigns, heirs, distributees, guardians and next of kin (herein the “Releasors”), release, waive, discharge and covenant not to sue Street 2 Street and its officers, directors, employees, and agents (herein the “Releasees”), from all liability to the Releasors, on account of injury to the Participant or death to the Participant or injury to the property of the Participant, whether caused by the negligence of Releasees or otherwise, while the Participant is participating in the Activity.

The participant and the parent/legal guardian (if Participant is under 18) are fully aware of the risks and other hazards inherent in the Activity and is allowing the Participant to participate in the Activity, and voluntarily assumes the Risks and all other risks of loss, damage, or injury that may be sustained by the Participant while participating in the Activity.

The participant has received, read and understands Street 2 Street’s Concussion Awareness and Safety Recognition Program, a copy of which is available at www.street2street.com. The undersigned has also completed the free online concussion course offered by the Centers for Disease Control and Prevention at www.cdc.gov/headsup/youthsports/training.

The participant acknowledges that as a part of this Release he or she shall be 100% liable to pay for all medical expenses resulting or to result from any injury incurred during, or as a result of, participation in the Activity.

The participant warrants that he or she has fully read and understands this Liability Release Agreement and voluntarily signs the same, and that no oral representations, statements or inducements apart from the foregoing written agreement have been made to the participant.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

Parent/Guardian Media Permission

I am the parent/legal guardian of the child named below, who is under the age of 18. I hereby provide permission to Street 2 Street to include certain personal information about my son/daughter/ward in connection with the support for publication in:

Promotional materials, press releases, newsletters, web site contents and in all media now known or hereinafter devised in perpetuity.

I understand that this media will be accessible throughout the world and that stories including my son/daughter/ward’s personal information may appear in written, video, electronic and other forms.

I understand that information provided by me on my son/daughter/ward will be used to promote Street 2 Street generally. I release Street 2 Street from any claims of infringement, invasion of privacy, defamation or misappropriation arising from the use of the information provided by me in the permitted manner.

I have read and agree to the above conditions*

YesNo

Signature*

After completing this form, please click Submit Form and 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 registration@street2street.com.