Rhea County Academy Warriors and Lady Warriors

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2015-16 Basketball registration form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

* Jersey Size:

* Pant Size:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

* Firstname:

* Lastname:

* Email:

* Home Phone:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

WAIVER INFORMATION

I, parent/legal guardian of the above named player, hereby give my approval for the registrant(s) to participate in any and all activities of Rhea County Academy basketball. I understand that basketball is an active sport in which players may occasionally sustain an injury. I do hereby relieve, waive, release, absolve, indemnify, and agree to hold harmless Rhea County Academy, including board members, coaches, managers, sponsors, supervisors, participants, persons transporting my child, and any volunteer associated with Rhea County Academy of any liability should the above named player be injured while participating in any league activity, whether the result of negligence or for any other cause except to the extent covered by accident and liability insurance.

I also understand that my son/daughter's name, information, and/or likeness (including picture) may be displayed on Rhea County Academy’s website or in the newspaper. I give my approval for the registrant(s) name, information, and/or likeness (including picture) to be used on the website of Rhea County Academy or in the newspaper.

I/we agree with the above *

* indicates required fields

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2015-16 Basketball registration form