Basketball Tournament Registration Form

Rising Stars Basketball Association Registration Form
(ages 6 to 16)
Mater Academy Charter High School 7901 NW 103rd St
Athlete Information
Player Name*
First NameLast Name
Age*
Guardian / Parents Names*
First NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Home Phone*
Area CodePhone Number
Cell Phone
Area CodePhone Number
E-mail*
Basketball skill level*

1 2 3 4 5
1 is Begginer, 5 is Advanced
Interested in Volunteering while your team is not playing?
CoachOperate Scoreboard
Important Notes
· Dress appropriately.
· Keep the gym clean.
. No food or drinks in gym, but those will be sold outside of the gym for participants and others.
· The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.
· Fee: $135 per participant. Includes insurance, full uniforms, 8 games plus playoffs, all star weekend, and weekly statistics.
. $5 fee for technical fouls to ensure proper sportsmanship. We are here to develop players and let them have fun with the game of basketball.
Emergency Contact & Health Insurance Information
Emergency Contact's Name*
First NameLast Name
Relationship*
Phone Number*
Area CodePhone Number
Do you have health insurance ?
YesNo
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 activtiy?*
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
Area CodePhone Number
Release of Liability
Although the safety of all sport activities is the primary concern, indoor sport activities at Rising Stars Basketabll Association 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 Rising Stars Basketball Association and the persons in charge.
I have read and agree to the above conditions*
YesNo
Parent's Signature/ Child's Signature*
Should be Empty:

Release of Liability