Retro Kids Hoops Registration Form 2024

Retro Kids Hoops Registration Form 2024
Athlete Information
Player Name*

First NameLast Name
DATE OF BIRTH*
CURRENT GRADE:
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
E-mail*
Uniform Size
Number (select three different numbers)
Shoe Size
Important Notes

· Dress appropriately.

· Keep the gym clean.

· The coaches reserve the right to form the teams to ensure the talents of all teams are balanced.

· Fee: $500 per participant. Includes insurance, full uniforms, practice uniform, first tournament cost.

. Each player is required to participate in team fund raisers.
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
Member 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
Registration & Uniform

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USDRegistration & uniform fee

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Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at Retro Kids Hoops & or 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 Retro Kids Hoops and the persons in charge.
I have read and agree to the above conditions*

YesNo
Parent's Signature/ Child's Signature*
Should be Empty:

Retro Kids Hoops Registration Form 2024

Release of Liability