CAPITOL AAU REGISTRATION FORM 2010 Season
(Please print)
ADDRESS_____________________________________________
CITY_____________________________STATE_______________
ZIP____________
DOB: _______________________HEIGHT:
__________________________________
PARENTS
NAME:______________________________________________________
PHONE
NUMBER:______________________________________________________
CELL PHONE:__________________PARENTS CELL
PHONE:________________
EMAIL:________________________PARENTS
EMAIL:______________________
EMERGENCY
CONTACT:_______________________________________________
PHONE NUMBER:_______________________________________
Medical Insurance
& Number:_____________________________GroupNumber:_____________________
SCHOOL
ATTEND:_____________________________________________________
UNIFORM SIZE:
Adult Shorts______ S M L
XL
SHIRT SIZE: S
M L XL
UNIFORM NUMBER:
FIRST PREFERENCE______ SECOND _______
I, being the parent of the above-named player, hereby give my approval for her participation in the Capitol AAU Basketball Club. I assume all risks and hazards incidental to such participation including transportation to and from activities; and I do hereby waive, release, absolve, indemnify and agree to hold harmless Capitol AAU Basketball Club, its officers, coaches, agents, partners being successors any sponsors, organizers, owners of facilities used, supervisors and participants for any and all claims arising out of injury to my child.
I
hereby authorized Capitol AAU Basketball Club officials, coaches, assistant
coaches, team parents, or any responsible persons delegated to any of the above
to take my child to the nearest hospital or any other accredited medical
establishment for emergency treatment in case of injury during practice and/or
games if the parents are not available.
I will assume any and all financial responsibility.
I
have read and fully understand the above conditions:
____________________________________________________ _______________________
Parent’s Signature Date