SPLASH BROS SPRING LEAGUE FORM (3RD-4TH & 5TH-6TH GRADE)

Player Full Name *

Shirt Size *

Registering as Individual or List Team Name (make sure Team name matches) *

Are there any days of the week that will NOT work for your player? *

Email address *

Street Address *

City, State, Zip Code *

Phone Number

Player Age / Date of Birth / Current Grade *

Parent/Guardian Name *

Emergency Contact & Phone Number *

Please list medical conditions and allergies *

Insurance Carrier Name & Policy Number *

By submitting this form you are agreeing to the Liability Waiver and Photo/Video release.

Liability waiver Splash Bros Basketball Spring League participant and/or their guardian, in consideration for the township and individuals assisting to provide facilities, instructions, transportation and supervision for the activity which the participant has registered does hereby: 1) Request to participate in said activity with the full knowledge the said activity could result in personal injury or damage to my personal property. 2) Assume all risks and possible damage or injury involved through participation in said. I understand I am to furnish my own insurance in case of injury. 3) Agree to indemnify and hold harmless the Township and its agents for personal injury. 4) I agree that Township shall have the right to enforce activity rules and terminate participation by anyone failing to comply with said rules. 5) I will furnish a certified certificate of birth or proof of birth of the above names upon request from program directors. 6) Waive the right to dispute all proper charges received. 7) I agree to reimburse township for any and all fees incurred for wrongfully disputing a credit charge.
Photo/Video release: I hereby give my permission for images of my child captured during basketball programs to be used solely for the purpose of Splash Bros Basketball promotional materials, publications and team photo galleries and waive any rights of compensation.