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Last
Update: June 16, 2009 Basketball Coaches Without Boundaries Fall Basketball League 2009 (Individual Registration Form)
Player
Name: ________________________________________ Adult, Boys,
Girls, Co-ED__________________________ Address:
__________________________________________________________________________________________
City,
State, Zip: _____________________________________________________________________________________
Phone:
______________________________________
Email:________________________________________________ Parent(s)/Guardian(s)
if under 18: _______________________________________________________________________
Height/Weight:
_______/_______Preferred Position: _________________________________________________________
Current
School ___________________________________________________ 2009-10
Grade Level ________________ High Level Played (circle all levels played, if any) 8th FR SO JV V Other ____________ Total enclosed: $________________ Medical
Release The
undersigned, being the player or parent/legal guardian of the player
requesting league admittance, does hereby affirm that the applicant is in
good health and suffers from no illness, disability, or condition that
requires the taking of medication on regular basis unless that condition
is disclosed and approved. Furthermore, the undersigned has no knowledge
of any reason the applicant cannot participate in vigorous physical
activity. The undersigned hereby expressly agrees to be responsible for
any medical bills incurred in the treatment of any illness or accident. In
the event of any such accident or injury, I hereby consent to allowing any
of the league supervisors to procure any medical treatment deemed
advisable on behalf of my child or ward without prior consent. I
understand that, as a condition of admittance as a league participant, the
undersigned, on behalf of all parents and guardians, and behalf of the
applicant, hereby release Basketball Coaches Without Boundaries and all
other employees or agents of the league from any and all liability in
regards to injury or illness, either mental or physical suffered by the
league participant during or related to the league by the person or entity
against which the claim is made. I
have read the above and agree to the league conditions: Player’s Signature Date: Parent/Guardian’s Signature (if under 18) Date: _______________________________________________ ________ ____________________________ ____ |