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Princeton Basketball Club Player Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

State:

* Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

Grade as of September 2015:

Current School:

Weight:

Height:

Uniform Size:

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult Extra Large

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:

WAIVER INFORMATION

Waiver
Agreement to Participate and Health Authorization:
I recognize and acknowledge that there are certain risks of physical injury inherent in __________________________’s (the Minor) participation in this program. I understand the risks and have discussed them with the Minor. The Minor understands that they must obey all rules and regulations, follow all safety procedures, and obey all program staff members.

I certify that the Minor is in proper physical condition for safe participation in this program and I agree that it is incumbent upon me to immediately inform program staff should the Minor’s physical condition change at any time prior to or during participation in the program.

I agree to waive, release, and relinquish any and all claims that the Minor and I may have against the Princeton Basketball Club, its officers, agents, servants, and employees which may accrue to me as a result of injury, death, damage, or other loss the Minor or I may suffer as a result of the Minor’s participation in this program, and I furthermore agree to indemnify, defend, and hold harmless the Princeton Basketball Club and its officers, agents, servants, and employees from any and all such claims.

I expressly agree that this agreement is intended to be broad and inclusive to the fullest extent permitted by the laws of the State of New Jersey and that if any portion of this agreement is held invalid, it is agreed that the balance shall continue in full legal force and effect.

I acknowledge that in the event of a serious accident or illness, it is the policy of the Princeton Basketball Club to contact appropriate emergency medical service to perform first aid and, when necessary, recommend transport to the hospital and attempt to contact the parent or guardian as soon thereafter as the situation allows.

By signing below, I acknowledge that I understand my responsibilities as outlined above.

I/we agree with the above *

* indicates required fields

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Princeton Basketball Club Player Registration