Youth Basketball League 2019 - Registration Form
Athlete Information
Player Name*
First Name Last Name
Are you over 18 ?*
Yes No
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Home Phone*
Area Code Phone Number
Cell Phone
Area Code Phone Number
E-mail*
Basketball skill level*
1 2 3 4 5
1 is Begginer, 5 is Advanced
Interested in Volunteering while your team not playing?
Match Referee Operate Scoreboard
I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.
Important Notes
· Dress appropriately.
· No food or drink 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: $15 (cash) per participant. All the money will be used for prizes and buying food drink for end of season small party.
Emergency Contact & Health Insurance Information
Emergency Contact's Name*
First Name Last Name
Relationship*
Phone Number*
Area Code Phone Number
Do you have health insurance ?
Yes No, I'll pay with cash.
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*
Yes No
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
City State / Province
Postal / Zip Code
Phone Number
Area Code Phone 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.
I have read and agree to the above conditions*
Yes No
Confirmation E-mail*
Signature*
Clear
Should be Empty:

Release of Liability