TJMS Basketball

2011-2012 Registration Form  

Welcome to Basketball Coaches without Boundaries who is the parent organization for TJMS Basketball Program.

Please print clearly and sign the form.

Player Information: (Print Clearly)

 

First Name                                                                     Middle Name                                         Last Name                                              

Address

City                                                              State                                           Zip

Email address                                                                                                 Birth Date Birth Date 

Parent, Guardian and Emergency Contact Information:

Print name of guardian/father or mother ____________ phone #  __________________________________          

Print name of emergency contact ____________ phone #  _______________________________________         

CONSENT FOR PARTICIPATION AND RELEASE OF LIABILITY: (Please Read and Sign)

IIWe, the undersigned parents and/or legal guardian of _____________________________ , the named child

registered for a roster position on the TJMS Mid Maryland Basketball Team  of Frederick, Maryland do hereby acknowledge and recognize the following:

1.       Give our approval to participate in any and all club activities for the 2011-2012 season.

2.       I/We consent to my/our child's participation in the basketball club with full knowledge of all risks and possible medical injuries which could occur from playing in the club and assume all risks and hazards incidental to such participation, including but not limited to; transportation to and from activities and I/We hereby waive, release, absolve, indemnify and agree to hold harmless the local club, the chartering organization, the organizers, sponsors, participants and persons transporting my/our child to and from the activities for any claim arising out of injury to my/our child, whether the results of negligence or from any other cause, expect to the extent in the amount covered by accident and liability insurance.

3.       I/We understand that the insurance carried by the club is secondary to any primary insurance and subject to coverage within the scope of the insurance carrier.

4.         I/We hereby acknowledge that my/our child is in excellent physical health and that I/We know of no reason whatsoever that my/our child's physical condition would prevent him/her from participating in all activities associated with the club.

5.       I/We agree to return, upon request, the uniform and other equipment issued to my/our child in as good as condition as when issued except for normal wear and tear.

6.       I/We have furnished a certified birth certificated for my/our child to the club officials.

7.       I/We authorize the BCWBRC/TJMS Coaches and staff the ability to make medical decisions in emergency situations requiring immediate action in the event I am not present. 

       8.       I/We authorize the use of our child’s picture to be used on our website or the Mid Maryland website.