Summer All Stars Basketball Parent Registration & Liability Waiver 🏀
Choose your program, complete parent and player details, add emergency/medical info, and review the liability waiver before signing.
Parent / Guardian Information
Parent / Guardian Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
City
*
State
*
ZIP Code
*
Player Information
Player Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Grade
*
Please Select
K
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Gender
*
Male
Female
School
T-Shirt Size
*
Please Select
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Add Another Child
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Parent
Guardian
Grandparent
Aunt/Uncle
Sibling
Family Friend
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Information
Does your child have any allergies?
*
Does your child have asthma?
*
Yes
No
Does your child carry an inhaler?
*
Yes
No
Does your child have any medical conditions?
Is your child taking any medications?
Does your child have any injuries or physical limitations?
Is there anything our coaching staff should know to safely coach your child?
Liability Waiver
Summer All Stars Basketball involves physical activity including running, jumping, cutting, contact with other participants, and basketball-related drills and games. I understand participation carries inherent risks including injury.
I certify that my child is physically able to participate.
I voluntarily assume all risks associated with participation.
I release and hold harmless Summer All Stars Basketball, its owner Alex Gerazounis, coaches, volunteers, employees, facility partners, and affiliates from any liability arising from participation except in cases of gross negligence or intentional misconduct.
I authorize Summer All Stars staff to seek emergency medical treatment if I cannot be reached.
I understand that Summer All Stars does not provide medical insurance and that I am responsible for all medical expenses.
I acknowledge that I have carefully read and understand this agreement.
I have read and agree to the Liability Waiver.
*
I have read and agree to the Liability Waiver.
Media Release
Do you give Summer All Stars Basketball permission to photograph or record your child during basketball activities for promotional purposes including our website and social media?
*
Yes
No
Digital Signature
Parent/Guardian Digital Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
🏀 Complete Registration
🏀 Complete Registration
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