FCYBO Basketball / Umatilla Elite Bulldogs

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2018 Travel Ball Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION
I hereby authorize FCYBO/Umatilla Elite officials. coaches, assistant coaches, team parents, or any other responsible persons to whom I have delegated supervision of the player to take the player to the nearest hospital or other known medical establishment for emergency treatment in case of injury during practice and/or games, if I am not available. I will assume any and all financial for such medical care.

Photo Permission
I grant permission for my child to be included in individual and group photographs at/and by FCYBO/ Umatilla Elite., Activities in connection with the organization publicity including, but not limited to print media, television broadcasts, and advertising handouts.

*** Consent and release waiver *** I the parent /legal guardian of the above named player hereby give my approval for her/his participation in any and all FCYBO Basketball, Umatilla Elite, practices, games and activities. I assume all risks and hazards incidental to such participation, including transportation to and from the games, practices and activities. I do hereby waive, release, absolve, indemnify and agree to hold harmless the FCYBO/Umatilla Elite Sponsors, organizers, coaches, supervisors, participants and the owners of facilities used by FCYBO/Umatilla Elite, for any and all claimed arousing out of injury to the player, except as covered by FCYBO/Umatilla Elite organizational team insurance.

I/we agree with all the above waiver, consent and releases for FCYBO Basketball/ Umailla Elite as listed on this registration. I also assume the reponsibility for the payment of any such treatment. This release is effective for a period of one year. *

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2018 Travel Ball Registration