Registration Form - 2018 Blazers Spring Basketball Programs

PLEASE NOTE: THE FOLLOWING SECTIONS OF OUR SPRING PROGRAMS ARE SOLD OUT:
- 6TH GRADE BOYS - MUD SEASON PICKUP BASKETBALL PROGRAM ON MONDAYS
- 7TH/8TH GRADE BOYS - MUD SEASON PICKUP BASKETBALL PROGRAM ON MONDAYS

.....BUT WE DO HAVE A HANDFUL OF SPOTS AVAILABLE FOR 6TH-8TH GRADE BOYS AS PART OF OUR 4TH-8TH GRADE BOYS PROGRAM ON WEDNESDAYS

IF YOU ARE INTERESTED IN BEING PLACED ON THE WAIT LIST, PLEASE EMAIL OPERATIONS@BLAZERSBASKETBALLCLUB.COM

Hi Parents/Players, please read the notes below before completing your registration.

Once you complete this form, you will be directed to our online Store where you can pay the registration fee with a credit card.

Note: When filling out this form, please use BOTH upper and lower case as appropriate (i.e., please do not leave ALL CAPS on when you fill this out). For player and parent first names, please provide just the informal name so the coaches will have that (ex: if the player goes by Chris, please type Chris not Christopher).

If you have any questions, please email operations@blazersbasketballclub.com.

Thank You!

REGISTRATION:

Question Title

* 1. Player Information:

First Name: *

Last Name: *

DOB (MM/DD/YYYY): *

Allergies or other Physical/Medical Concerns:

Medical Insurance: *

Policy #: *

Question Title

* 2. The Player is in what Grade?

Question Title

* 3. Gender of Player:

Question Title

* 4. What Town is the player from?

Question Title

* 5. Parent1 Information

First Name: *

Last Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Cell Phone: *

Email Address: *

Question Title

* 6. Parent2 or Other Emergency Contact

First Name:

Last Name:

Cell Phone:

Email Address:

Question Title

* 7. What Grade/Program are you registering the player for?

Question Title

* 8. Terms and Conditions:
Waiver: As the parent or legal guardian of the participant named above, I hereby give my full consent and approval for my child to participate in the tryout process, and if selected for a team, to join and participate on a team (collectively, the "Program"). I understand that there are certain risks of injury inherent in the practice and play of this sport, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed above. I understand that my medical insurance is expected to cover the cost of my child’s injuries. I grant permission to the coaches or volunteers involved with this Program to seek medical care in the event I cannot be reached. I agree not to hold Alpha Youth Sports, or any of the parties/facilities connected with this Program, responsible for any injury or accident that may occur during the program, whether the result of negligence or any other cause.

Video Release: For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of my child and the recording of my child's voice by Alpha Youth Sports, Inc. (“AYS”) during this Program. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage. Provided that AYS does not identify my child's last name, nor town of residence, in these photographs or recordings, I irrevocably consent to the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes, as well as to the reproduction and/or authorization by AYS to reproduce and use said photographs and recordings of my child's voice, for use in all domestic and foreign markets. I hereby release AYS, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies or other assigned third parties, their directors, officers, agents and employees from all claims of every kind on account of such use.

Program Dismissal: I understand that if my child becomes a discipline problem, he/she will be dismissed from the Program, and that no money will be refunded.

Do you acknowledge your understanding and acceptance of these Terms and Conditions?

Yes