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SUMMER 2017

2017 Registration Form
General Information

Player’s Name

Current Address City Zip_______

Grade (2016-2017 school year)

Date of Birth______________________Height________________________

Parent#1 Name___________________Parent#2 Name_________________

Parent#1 Email____________________Parent#2 Email_________________

Parent#1 Phone___________________Parent#2 Phone_________________

T-Shirt Size YS YM YL S M L XL

Warm-up Size YS YM YL S M L XL

Jersey Top Size YS YM YL S M L XL

Jersey Bottom Size YS YM YL S M L XL

Player’s Twitter Handle (optional) __________________________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Medical Information

Does your child wear glasses? Yes No

Does your child have asthma? Yes No

Does your child have diabetes? Yes No

Does your child have epilepsy? Yes No

Does your child have allergies? Yes No

Does your child have hearing deficiencies? Yes No

Does your child require medication? Please List. ___________________________

___________________________________________________________________

Does your child have orthopedic information? Please Describe. _______________

___________________________________________________________________

Please add any additional comments you may have on your child’s health. ______

___________________________________________________________________

Health Insurer_______________________________________________________

Policy Number_______________________________________________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Waiver and Release

We (or I), hereby certify that we (or I) are the parents/guardians of the above-named Participant, and as
such hereby request that you accept this application of the above-named Participant for the 3Twenty3
Select Basketball Program and participation in tournaments organized by 3Twenty3 Sports and
3Twenty3 Select. We hereby release 3Twenty3 Sports, all other program sponsors, all administration,
employees, and coaches of 3Twenty3 Sports from any and all claims for which I or we or the Participant
might have, or in the future might claim to have for injuries or damages of any kind or nature, whether
known or unknown, arising from or in any way connected with the Participant’s involvement or
participation in the program or any other activity sponsored by 3Twenty3 Sports, and their respected
sponsors, administrators, employees, and coaches for any claim which may hereafter be presented by
the Participant as a result of any such injuries.

We (or I) hereby further give our (my) permission for, to-wit (A) the Participant to ride to Program
activities with any coach, person, or other entity described herein, and (B) in our (my) absence, any
persons or other entity described here into consent to any necessary emergency X-ray examination,
anesthetic, medical or surgical diagnosis or treatment, and/or hospital care, in the event of any injury to
the Participant while participating in or traveling to any program activity.

We (or I) hereby further give our (my) permission for access that the Participant’s photo and name may
be displayed on the internet, which includes, but is not limited to, Facebook, Twitter, and the
3twenty3sports.leagueapps.com website.

By signing this document, we (or I) hereby further certify, warrant, and provide permission for my child
to be a part of 3Twenty3 Sports and 3Twenty3 Select from today’s date through August 30, 2017. We (or
I) hereby further certify, warrant, and represent to 3Twenty3 Sports and 3Twenty3 Select that,

____________________________________________________________, a physician duly licensed to

practice medicine in the State of Nebraska, last examined the Participant on _____________________
and found that the participant was and is able to participate in any and all type of basketball activities
without restriction of any kind.

Signed (Participant)______________________________Date_________________
Signed (Parent/Guardian)_________________________Date_________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Policies and Procedures
Sportsmanship Policy
The purpose of 3Twenty3 Select is to provide young men the opportunity to learn the fundamentals of the game
and to develop their individual skills. In order to succeed, parents and players must exhibit good sportsmanship in
practice and game situations. This means:

 Accept the decisions of officials with good grace.
 Demonstrate good sportsmanship before, during, and after games, win or lose.
 Be responsible for the sportsmanship of teammates and assist in maintaining a respectful environment
for all participants.
 Be courteous to opposing teams, officials, monitors, or facilitators and treat all players and officials with
respect.
 Help to maintain and keep all equipment and conditions at the facility/park in good condition.
 Obey all facility rules, while respecting all equipment, common areas, playing areas, parking areas, and
surrounding neighborhoods.
 Refrain from the use of abusive language or profanity.
 Not engage in any behavior which would endanger the health, safety, or wellbeing of any player, official,
staff member, or spectator.
 Not engage in verbal, written, or physical threats or abuse aimed at ANY participant, official, staff
member, or spectator.
 Not initiate a fight, scuffle, or exchange with any individual (including but not limited to: pushing, shoving,
punching, kicking, etc.).
 Not use alcoholic beverages or illegal drugs at any location unless permitted by the facility/venue.

Any unsportsmanlike or inappropriate behavior by parents or players may result in disciplinary action to include,
but not limited to, warnings, removal from practice, loss of game playing time or removal from the team.

Drug and Alcohol Policy
Participants must adhere to the following policy: Use, possession, distribution, or sale of alcohol, tobacco,
narcotics, other illegal drugs, "look-alike" drugs, steroids, or drug paraphernalia is prohibited. If a player is
determined to be in violation of the above prohibited activity, he shall forfeit the privilege of participating in the
Program for the remainder of the season. This determination shall be made by the 3Twenty3 Select
Administration.

We hereby agree to fully adhere to the above policies and procedures while a part of the 3Twenty3 Select
Program:

Signed (Participant)______________________________Date_________________
Signed (Parent/Guardian)_________________________Date_________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Tournament Interest and Practices
In order to be flexible with everyone’s summer schedules, we need to gather information
regarding the amount of tournaments and available tournaments your child can/wants to
attend. Teams will be organized by skill level on a week-to-week basis that reflect each
participant’s availability. Each tournament will include an additional fee of $55 per player per
tournament. All tournaments will take place on Friday, Saturday, and Sunday. Potential
tournament locations can be found on the next page. Please check your calendar and provide
the following information, which will be used to determine how many and what tournaments
your child will attend.

1) What is the minimum number of tournaments you and your child want him to attend
from May 12th, 2017 through July 30th, 2017?

1 2 3 4 5 6 7 8 9 10

2) What is the maximum number of tournaments you and your child want him to attend
from May 12th, 2017 through July 30th, 2017?

1 2 3 4 5 6 7 8 9 10

3) What is the ideal number of tournaments you and your child want him to attend from
May 12th, 2017 through July 30th, 2017?

1 2 3 4 5 6 7 8 9 10

We would also like to know what days/nights work best for our weekly practices. Please
comment which times of the week work well for you and which times you cannot make.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Tournament Availability
In order to be flexible with everyone’s summer schedules, we need to gather information regarding the
amount of tournaments and available tournaments your child can/wants to attend. Teams will be
organized by skill level on a week-to-week basis that reflect each participant’s availability. Each
tournament will include an additional fee of $55 per player per tournament. All tournaments will take
place on Friday, Saturday, and Sunday. Potential tournament locations are listed below. Please check
your calendar and provide the following information, which will be used to determine how many and
what tournaments your child will attend.

Instructions: Please cross out the tournaments your child CANNOT attend. Please do not mark the
tournaments that you are interested in going to. Please circle the tournaments you strongly WANT your
child to attend.

May 12-14 June 9-11 July 7-9
Wichita, KS Wichita, KS Lawrence, KS
McPherson, KS (Sat/Sun Only)
May 19-21 June 16-18 Sioux Falls, SD
Des Moines, IA Topeka, KS
Wichita, KS Lincoln, NE July 14-16
Omaha, NE Norfolk, NE Wichita, KS
Salina, KS (Sat/Sun Only) Emporia, KS
May 26-28 Buhler/ Hutchinson, KS
Omaha/ Council Bluffs, IA June 23-25 Omaha, NE
West KC/ Bonner Springs, KS Des Moines, IA
Wichita, KS Omaha, NE July 21-23
Harrisburg/ Sioux Falls, SD Wichita, KS
June 2-4 Lincoln, NE
Des Moines, IA June 30-2 Sioux Falls, SD
Hays, KS Des Moines, IA Salina, KS (Sat/Sun Only)
Wichita, KS Bonner Spring, KS
Omaha, NE Emporia, KS July 28-30
South Sioux City, NE Lawrence, KS Wichita, KS
Omaha, NE Riley County, KS
Kansas City, MO
Omaha, NE

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
Fees and Fundraising Opportunities

The initial program fee for the 3Twenty3 Select program is $250 per player. This program fee will cover
many expenses and supply your child with the individual instruction he needs to further develop his
basketball skills. This fee is responsible for:

1. Practice facility fees
2. Well-trained, paid coaches from around the area
3. Individual two-sided (white and navy blue) jersey tops and bottoms
4. Individual player warmups
5. Skills training
6. Administrative duties
7. Opportunities to develop new friendships while enjoying the game of basketball

In addition, a fee of $55 per player will cover each tournament your child wishes/able to attend. For
example, if your child wants to go to 4 tournaments, the additional tournament fee will amount to $220.
This individual tournament fee is an average of tournaments around the area that covers entry fees for
MAYB and other select tournaments.

FUNDRASING OPPORTUNITIES

Our program will provide your child with two fundraising opportunities during the spring to help reduce
the cost of our program. First, in the first few weeks, we will be sending out a T-shirt order form with
your child with an opportunity to sell shirts to discount or grant your child a free tournament. We will
provide you with more information on this in the near future.

The following page is also another way for your child to get free tournaments. Each player has the
opportunity to go out and receive 5 or 10 sponsors. These sponsors can be businesses, family members,
friends, or any other entity you can get to donate. Each sponsor can donate $10 and their name will be
placed on the back of that grade level’s T-shirt. Five total sponsors will get your child one free
tournament and ten total sponsors will get your child two free tournaments. There is a max of 10
sponsors for this fundraising opportunity. You must gain either 5 or 10 sponsors to gain the benefits for
this fundraiser.

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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2017 Registration Form
T-Shirt Sponsorships
Please list the following sponsor’s names as they would like to appear on the T-shirt. Then,
enclose the total sponsorship amount in the provided envelope.

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

5. ________________________________________________________________

6. ________________________________________________________________

7. ________________________________________________________________

8. ________________________________________________________________

9. ________________________________________________________________

10. ________________________________________________________________

Email: 3twenty3sports@gmail.com
Website: 3twenty3sports.leagueapps.com
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