Child's Information

Child's Name

Date of birth

Grade

Gender

Basketball Jersey Size

Does your child have any experience with Basketball? If so please explain.

Parent/Guardian Info

#1 Parent/Guardian Name

Would you like to be an assistant coach for your child's team?

Yes No

Email #1

This address will receive a confirmation email

Phone

Address #1

#2 Parent/Guardian Name

Would you like to be an assistant coach for your child's team? Yes No

Email #2

This address will receive a confirmation email

Phone #2

Please read carefully and check the box below to indicate your agreement .

I understand and agree that my child's participation in athletic and other activities of the program necessarily involves the risk of injury and even death from various causes. On behalf of my child I assume these risks. In consideration of the privilege of my child?s participation in the Program and on behalf of my child and me as the parent/guardian I hereby release, discharge, hold harmless and indemnify and covenant not to sue the church and all of the church?s directors, officers, elders, trustees, deacons, employees, volunteers, insurers, agents and representatives and all other persons associated with the program as to any and all claims of my child, me and other family members for personal injuries suffered by my child, property damage, medical expenses and economic loss arising directly or indirectly out of my child?s participation in the program. I understand that participation in the program may involve strenuous and prolonged physical activity. I agree that my child is healthy and able to participate in the program activities.

Yes, I agree

Payments

Payment Information

Every child will receive one concession token.

Payment

Office Use Only

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Basketball Registration

Payment Information

Description

Basketball Registration

Payment Information

Description

Please Fix the Following