Registration Form

REGION ELITE BASKETBALL REGISTRATION FORM

FOR OFFICE USE ONLY:

REG. FEE PAID ___________     _______ CK# / CASH ________   INPUTTED BY ________ DATE _________ 

PLAYER’S LAST NAME____________________PLAYER’S FIRST NAME __________________  

ADDRESS _____________________________________ CITY _______________________

STATE _____________ZIP ____________ TELEPHONE # ____________________  

CELL#____________________BIRTHDATE _______________ AGE ______ GRADE _______

FATHER’S NAME ___________________MOTHER’S NAME ___________________________  

SCHOOL __________________________ EMAIL ADDRESS __________________________

PLEASE READ!

I, PARENT OR GUARDIAN OF THE ABOVE NAMED PLAYER HEREBY GIVE APPROVAL FOR PARTICIPATION IN ANY AND ALL THE REGION ELITE ACTIVITIES. I HEREBY GRANT PERMISSION TO MANAGING PERSONNEL OR OTHER LEAGUE REPRESENTATIVE TO AUTHORIZE AND OBTAIN MEDICAL CARE FROM ANY LICENSED PHYSICIAN, HOSPITAL OR MEDICAL CLINIC SHOULD THE PLAYER BECOME ILL OR INJURED WHILE PARTICIPATING IN LEAGUE ACTIVITIES AWAY FROM HOME, OR WHEN NEITHER PARENT OR LEGAL GUARDIAN IS AVAILABLE TO GRANT AUTHORIZATION FOR EMERGENCY TREATMENT. I ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO SUCH PARTICIPATION, INCLUDING TRANSPORTATION TO AND FROM ACTIVITIES, AND DO HEREBY WAIVE, RELEASE, ABSOLVE, INDENTIFY AND AGREE TO HOLD HARMLESS THE LOCAL LEAGUE ORGANIZATION, PRACTICE FACILITY, SPONSORS, SUPERVISORS, PARTICIPANTS AND PERSONS TRANSPORTING THE PLAYER TO AND FROM THE ACTIVITIES, FOR ANY CLAIMS ARISING OUT OF INJURY TO THE PLAYER. I/WE PARENT, GUARDIAN OR PARTICIPATE OF THE ABOVE NAMED CANDIDATE, DO HEREBY GIVE MY/OUR APPROVAL TO HIS/HER PARTICIPATION IN ALL ACTIVITIES. I AGREE TO RETURN ANY UNIFORM OR EQUIPMENT ISSUED TO MY SON/DAUGHTER AT THE END OF THE SEASON, AND FURTHER AGREE TO PAY FOR ANY EQUIPMENT OR UNIFORM LOST OR NOT RETURNED.

SIGNED

_____________________________________________________________________ PARENT OR GUARDIAN

WE ASK FOR ACTIVE PARTICIPATION OF ALL PARENTS IN OUR PROGRAM. CHECK AREA (S) IN WHICH YOU WOULD BE WILLING TO HELP.

  BOOSTER CLUB              COACH                                          CONCESSION STAND

  VIDEO TAPE                  TUTORING/EDUCATION                   PHOTOGRAPHER (website)

  TEAM MOM                    NEWS ARTICLE WRITER (website)     EVENT PLANNER

THIS RELEASE FORM MUST BE SIGNED BY THE PARENTS AND RETURNED TO THE REGION ELITE (COACH) ALONG WITH REPORT CARD, BIRTH CERTIFICATE AND COMMITMENT FEE.

 MAKE ALL CHECKS PAYABLE TO: “REGION ELITE”