Beyond Basketball

Registration FORM / Sign-Up Sheet

Participant/Player First Name _________________________Middle ____________Last ___________________ Gender: Male __ Female__ Uniform Size ___________ Uniform # ____ (not guaranteed) School Name __________________________________ Grade _______ Birth date _____/_____/______ Age __________ Street Address (please print) ____________________________________________________________________________ Town/City ___________________________ State ______ Zip code ___________ Child’s Home Phone _______________________ Parent/Guardian - Contact Information Parent/Guardian First_______________________________________Last______________________________ Home Phone ____________________ Cell Phone _____________________ E-mail ______________________________

Emergency contact(s) if parent/guardian cannot be reached:

Name: __________________________Cell#______________________________________

Insurance Information

Medical Carrier____________________________ Policy #________________________

Subscriber’s Name _________________________ (the person whose name the policy is on)

REQUIREMENT:

ALL PLAYERS MUST

1. MUST PAY PLAYER TRYOUT FEE OF $25 - PAYMENT DUE AT TIME OF REGISTRATION

Please make checks payable to New England Hoops Academy

Beyond Basketball

Terms of Agreement Participants/Players Name: _________________________________________________ Photo Release

I hereby give permission for my child to be photographed during the New England Hoops Academy tryouts, practice, games and program. I understand the photos will be used to keep a journal of

activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of New England Hoops Academy and its affiliates.

Parent’s/Guardian’s Initials ____________ New England Hoops Academy and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred. In case of an emergency, and if a family member cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). I understand that this sport involves physically and mentally strenuous activities that could result in injuries, including death, and I willingly assume all risks associated with such participation. I hereby certify that my child has no physical injury, disease or ailment that would prevent my child from participating fully in activities related to the Program. I further agree that unsportsmanlike and/or unsafe conduct will not be tolerated and my child may be removed from the Program for such conduct in its sole discretion and any further participation in the Program shall be ended. If my child is removed for unsportsmanlike and/or unsafe conduct, all fees paid for Program participation will be forfeited.

Parent’s/Guardian’s Initials ____________ In exchange for and in consideration of New England Hoops Academy permitting my child to participate in the Program, I agree further to hold harmless and indemnify, its trustees, officers, agents and employees from any and all liability, actions, causes of action, negligence, debts, claims or demands of any kind and nature whatsoever (including attorneys’ fees and costs) by my child, any other person which may arise by or in connection with my child’s conduct while participating in the New England Hoops Academy Program.

Parent’s/Guardian’s Initials ____________

NOTE: All applicants enrolled in the New England Hoops Academy Program must have their own insurance coverage. New

England Hoops Academy does not assume responsibility for sickness or accidents sustained during the athlete’s participation in the

Program. Expenses resulting from injury or illness during this time are the responsibility of the participant and/or his/her parents or

guardian.

Guardian Signature: _______________________________________Date: _______________ Printed Name of Parent/Guardian: _______________________________________________