Basketball League Registration Form

Portsmouth City Sports Club, Inc

Basketball-Registration Form (Girls and Boys)

(age 4-15)(The age that they are on July 31st, 2022, is the childs playing age)

Athlete Information

Player Name*

First NameLast Name

Date of Birth*

Girl or Boy*

Top Size and Bottom Size (Youth or Adult)*

Name Written on back of top*

Player Name

First NameLast Name

Date of Birth

Girl or Boy

Top Size and Bottom Size (Youth or Adult)

Name Written on back of top

Player Name

First NameLast Name

Date of Birth

Girl or Boy

Top Size and Bottom Size (Youth or Adult)

Name Written on back of top

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Cell Phone

Area CodePhone Number

E-mail

example@example.com

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.

Important Notes

· Dress appropriately.

· No outside food or drinks in the gym.

· Keep the gym clean.

· The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.

· Fee: $60 per participant plus $50 mandatory fundraising/Buyout (We would rather you do the fundraiser than the buyout). All monies will be used for funding of basketball season, Portsmouth Park & Rec Card, trophies, uniforms, referees, tournament cost, league insurance, after season celebration and more.

Emergency Contact's Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at Youth 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 Youth Sport Center and the persons in charge.

Please Read:

Portsmouth City Cowboys 2022-23 Basketball Contract

The registration form, a copy of your child's birth certificate are due by November 28th. Your athlete must participate in the first fundraiser. You will get information when you register. If you do not want to participate in the fundraiser, the buyout fee is $50. Basketball registration fees are $60 per child, and that is a non-refundable fee. Nobody will be allowed to practice unless registration is fully paid, and no athlete will be able to participate in games unless fundraising monies are paid. Registration and fundraising monies cover funding of basketball season, such as uniforms, referees, tournament cost, storage cost, after season celebration and more. Basketball registration includes a personalize basketball jersey with shorts, and a recreation card which gives you access to all Portsmouth recreational facilities for 1 year.

If you agree with the Portsmouth City Sports Club Basketball 2022-23 Contract, please sign below:

Signature*

After completing this form, please click Submit Form. 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 portsmouthcitycowboys@yahoo.com.

Add Notes

My Products*

Basketball Registration$60.00

Quantity
Item subtotal:$0.00

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