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Players Name ______________________________________________ Date of Birth: _______________
Address _________________________________ City ___________________ St _____Zip __________
Phone (Home) _________________________ Email ________________________________ (parents or yours)
Date of Birth: ________________ Ht. _____ Adult Tee Shirt Size: _________
PAYMENT Information: Bring this with you the first time you come to Hoop City.
______ Check via Mail ______ Money Order Credit Card (Master Card of Visa) Credit Card No. __________________________ Expiration: ________
Name on It ________________________ Credit Card Signature: _________________________________
Permission and Liability Waiver
I give permission to my son/daughter to participate in the activity at Hoop City or event sponsored by Hoop City. I further understand that participation is such activities may cause injury to my son/daughter just by the nature of the activity. I take full responsibility for any injuries suffered by my son/daughter and will hold Hoop City Basketball, LLC, Hoop City Jenison Partnership, the partners of such, and the staff of Hoop City harmless for any injury, loss or damage.
I further assure that my son/daughter has no health problems that would prevent them from full participation in the activities involved in the event they are registering for. I am solely responsible for their safety and have fully inspected the facilities used by Hoop City to host such activities. I take responsibility for monitoring their physical condition during such activities, even though I might not be in attendance.
I fully release Hoop City Basketball, LLC, Hoop City Jenison Partnership, its sponsors, staff, instructors, officers, agents, partners and any representatives of any liability, loss, or legal action and further agree that this applies to my heirs, assigns and persons acting on my behalf, including a coach, parent, or guardian.
I have checked the capabilities and background of the individuals participating as coaches or instructors of the activities my son/daughter have participated in and fully release Hoop City Basketball, LLC, Hoop City Jenison Partnership, its sponsors, staff , instructors, officers, agents, partners and any representatives of any liability, loss, or legal action associated with that coach, coaches, or instructors.
I have read and fully understand the above Permission and Liability Waiver and agree to abide by it.
Parent/guardian Signature: _______________________________________ Date: _________________________
Hoop City - 596 Baldwin (in the Soccer Zone Bldg next to Meijer) Jenison, MI 49428 616-957-HOOP (4667) - HoopCity2@aol.com
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