Basketball Registration Forms 2010

Pine Forest UMC Basketball Registration Form

Name of player: Age: Grade:

DOB:

Address: City Zipcode

Home Phone: Cell Phone(s):

Work Phone(s): E-mail:

Parents’ Name(s): Parent willing to coach: Yes No

Parent willing to volunteer: Yes No

Have you already formed a team? . If yes, then what team?

If you are not on a team, then we will place you on a team to play Basketball. Will you comply with our decision? .

Emergency Contact Info (other than the parents):

Name: Phone:

Fees paid by: Cash Check No. Payment received by:

Shirt Size (circle one): Y-Small 6-8 Y-Medium 10-12 Y-Large 14-16

A-Small A-Medium A-Large A-Xlarge A-XXlarge

We would like to start our Basketball season by Monday, March 8, 2010

You can only practice in the Gym if you are a registered team member!

Medical/Liability Release and Insurance Information Form

Pine Forest UMC will not be responsible for any personal injury or property damage to the undersigned team, organization, or individual members thereof. By participating in any activities on or related to property owned or operated by Pine Forest UMC, you will assume all risk associated with any injury or damage that may occur. You or your organization must supply the insurance information listed below before being allowed to participate in the activities for which you are registering. In the event there is a claim of any type made or filed you must agree to hold harmless and indemnify Pine Forest UMC from any claim of any type for damages and attendant costs or attorneys’ fees. Consideration for assuming such obligation will be permission for your participation in the activity.

Name of Insurance Company: Policy #

Parent/Registrar Signature: Date:

PLEASE PRINT THIS FORM AND SEND IT IN WITH YOUR PAYMENT OF $45 PER PLAYER TO PINE FOREST UMC