Basketball League Registration Form

1MoreAthletics Basketball League Registration Form
League Information Form
Athlete Information
Player Name*

First NameLast Name
Age
Birthdate

MonthDayYear
Date
Height:
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
E-mail*
example@example.com
Jersey Size
Basketball skill level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Current Level of Play (specify below)
Specify current Grade or Highest level of play. (MIN GRADE: Must be entering Junior Year)
Highschool/College Name :
Individual or Team Registration
If you selected team registration, indicate team with whom you are playing. If you selected individual registration, indicate with whom you would like to play. League organizers will form teams based 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
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.
Upload photocopy of Insurance Card

Cancelof
Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at the Andreasen Center for Wellness may cause serious injuries. I expressly assume the risk of injury and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Andreasen Center for Wellness and the persons in charge.
YesNo
Confirmation E-mail*
example@example.com
My Products
prevnext( X )
Player Registration FEE
$110.00 Quantity

Team Registration FEE
$1,200.00 Quantity

Total

$0.00
Signature*

Powered by Jotform SignClear

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

1MoreAthletics Basketball League Registration Form

Release of Liability