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Basketball Training Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

* City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

* Gender:

* Grade Entering Fall 2014:

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 #:

As lawful consideration for my minor child being permitted to participate in the Southern Illinois Storm Basketball Training, Basketball Camps, Basketball Team Camps, Clinics.
I agree that neither my minor child nor I will make a claim against, sue, attach the property of or prosecute Southern Illinois Storm and any buildings or schools they use,their agents, sponsors, building contractors, suppliers, and employees for damages for death, personal injury or property damage which my minor child may sustain as a result of my child's participation in these
sporting activities. This release is intended to discharge in advance SOUTHERN ILLINOIS STORM from and against any and all liability, including for negligent
actions, arising out of or connected in
any way with my minor child's participation in the sports league,
program, camp, clinic or any other activity except for liability
that may arise out of the willful or wanton misconduct of SOUTHERN ILLINOIS STORM and their agents,sponsors and employees. I FURTHER UNDERSTAND THAT SPORTS INVOLVE PHYSICAL CONTACT BETWEEN PLAYERS, THAT SERIOUS ACCIDENTS OCCASIONALLY OCCUR DURING SUCH SPORTING ACTIVITIES, AND THAT PARTICIPANTS IN SUCH SPORTING ACTIVITIES OCCASIONALLY SUSTAIN SERIOUS PERSONAL INJURIES (INCLUDING DEATH)
AND/OR PROPERTY DAMAGE, AS A CONSEQUENCE THEREOF. KNOWING THE RISKS OF PARTICIPATION, NEVERTHELESS, I HEREBY AGREE THAT MY MINOR CHILD AND I ASSUME THOSE RISKS AND RELEASE AND HOLD HARMLESS SOUTHERN ILLINOIS STORM AND THEIR AGENTS,SPONSORS AND EMPLOYEES WHO (THROUGH NEGLIGENCE OR CARELESSNESS) MIGHT OTHERWISE BE LIABLE TO ME.
MY MINOR CHILD (OR OUR HEIRS OR ASSIGNS) FOR DAMAGES.
I attest that I am eighteen (18) years old or older and
that my child is physically fit and have no known medical conditions which prohibit participation
in this sport. My child and I agree to follow all laws, rules
and guidelines regulating the conduct of the league, camp or clinic. I understand and agree
that my child and I are responsible for the mechanical and/or
operating condition of any and all sporting equipment provided by
my child or by me for my child's use, and I agree that my child and I will continuously inspect and maintain all equipment used, even if we have obtained any of the equipment from SOUTHERN ILLINOIS STORM, their agents, sponsors and/or employees.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERS
TAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF
LIABILITY FOR MYSELF AND MY CHILD AND A CONTRACT BETWEEN
MYSELF, MY CHILD AND SOUTHERN ILLINOIS STORM AND THEIR AGENTS, SPONSORS AND EMPLOYEES, AND I HAVE SIGNED IT OF MY OWN FREE WILL.
I also agree that SOUTHERN ILLINOIS STORM and their agents, sponsors
and employees may use my child's
photograph in future
promotions.

I/we agree with the above *

* Basketball Camp Interested In Attending:

* indicates required fields

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Basketball Training Registration