Impact Sports

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Player 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 #:

MEDICAL WAIVER AND RELEASE
lmpact Sports and any facilities or fields where tryouts, practices, or games will be played will assume no liability for injury or damages arising from the results of the above-named Athlete’s participation unless due to willful misconduct or gross negligence on the part of Team Impact Basketball, its affiliates, or agents. Due to the strenuous nature of basketball, the Athlete participating and their parents are urged to consult with their physician concerning the Athlete’s fitness to participate. Basketball presents certain inherent risks and hazards, which the participating Athlete is urged to consider and which the Athlete assumes the outcomes of such risks and hazards.
I hereby approve of the participation of my child, the above names Athlete, in the Team Impact Basketball tryout program and consent to the emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child’s participation.

WAIVER INFORMATION

*** Insert your waiver information here ***

I/we agree with the above *

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