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Player Registration Form

Please send completed form with payment to: Middleton Youth Basketball c/o Treasurer P.O. Box 402 Middleton, MA 01949 Email questions to: middletonyouthbball@gmail.com

This registration form is for the new in-town Middleton Youth Basketball league (not to be confused with any other local or regional youth sports programs). Players Name: __________________________________Male___ or Female___ Age: ____ Birth Date: _____________________ Grade as of September 2011: K 1 2 3 4 5 6 Shirt Size: Youth XS Youth S Youth M Adult S Adult M Adult L Adult XL Parents or Guardians: _____________________________________________________________________________________ Home Phone: ___________________ Cell Phone: _____________ Email: ____________________________________________ Address: _______________________________________________________________________________________________ City: ________________________________________________________ State: ___________ Zip Code: __________________ Physician: __________________________________________________ Physician Phone: ______________________________ Any Medical Conditions, Allergies, ETC: ________________________________________________________________________ _______________________________________________________________________________________________________ *Please inform the coach of these conditions prior to the first practice/game. Sport Fees: $50.00 (Please make check payable to Middleton Youth Basketball.) Parent/Guardian Participation: The new in-town Middleton Youth Basketball program is run by volunteers. All funds collected go directly toward running the program. Team sponsors and coaches are needed. I/We are willing to participate in the following ways (please check all that apply): Coach (Volunteers must submit to background checks and attendance is expected at coach meetings and clinics if applicable.) Sponsor Consent/Waiver Agreement: I/We consent to our child participating in the new in-town Middleton Youth Basketball program. In participating in the new in-town Middleton Youth Basketball program, I hereby acknowledge that I/We understand that there are risks of accidents resulting in bodily harm arising out of those activities. I/We understand that the new in-town Middleton Youth Basketball activities are planned with the safety of the participants in mind. In case of emergency, accident or illness, if I/We am not present I/We hereby give our permission for the coach or representative of the new in-town Middleton Youth Basketball program to obtain any required medical attention my child may need. I/We will notify the coach of any physical limitations (allergies, hearing, sight, etc) or other additional information they need to know about my/our child. I/We further acknowledge that my child has the physical capacity reasonably necessary to engage in new in-town Middleton Youth Basketball activity for which I have enrolled. I/We agree to be the party responsible for all medical expenses which are incurred in my behalf. It is understood and agreed that the new in-town Middleton Youth Basketball program, its organizers, directors, volunteers and agents shall be held harmless against all claims, damages, loss or expenses including attorneys fees arising out of or resulting from participation in the new in-town Middleton Youth Basketball program. I/We agree any pictures taken may be used for future promotions for the new in-town Middleton Youth Basketball program. I have read the above waiver and understand the contents. ____________________________________________________________________________________________________________ SIGNATURE (PARENT OR GUARDIAN) Date