Beyond Basketball Travel Program Registration Form

Beyond Basketball Travel Program Registration Form

• Boys (Ages 6 to 16) Charlotte NC

Donate To Venmo / Cash App $IAmWeFoundationCLT

IAmWeFoundation@hotmail.com

📞 980.272.1198

www.IAmWeFoundationCLT.org

Athlete Information

Player Name

First NameLast Name

Age

Date of Birth

Grade

Height

School Name

Shoe Size

Second Player Name

First NameLast Name

Age

Grade

Date of Birth

Player T-shirt Size

Basketball skill level

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Assistant living (IE - Group Home, Halfway Housing or Shelter )

Single Parent

Two Family Household

Guardian / Parents Names

First NameLast Name

2nd Guardian / Parents Names

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

Household Income

Interested in Volunteering (Coaching, Community Events, Organization Staff)

Emergency Contact & Health Insurance Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Do you have health insurance ?

Insurance Carrier

Name of Policy Holder

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

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

Area CodePhone Number

Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities with Beyond Basketball Program using Rental 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 I Am We Foundation and the persons in charge.

I have read and agree to the above conditions

Parent's Signature/ Child's Signature

Important Notes · Dress appropriately in Beyond Basketball Work Out Attire. Keep the gym clean and Transportation. Season Fees: Winter $100.00, Fall $150, Spring/Summer $300-$400.00 per participant Depending Team Skill level. Scrimmage Games, Skills & Drills Clinics and Work Outs Events, Tournaments, Educational Tours, Bike Riding, Boxing, Physical Fitness and Community Events. We are here to develop players and let them have Fun and learn More Beyond basketball. (Deposits Available) ask about Scholarships, Multiple Player and other Discounts.

Signature