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Player or Team Name ______________________________________ Email:_____________________________ Team Coach ______________________________ Phone ______________ Email ________________________ Grade _______ Date of Birth (DOB) ___/___/___ (month/day/year) Male _____Female _____
List Players on a team list and waiver form. See Gary Wilfong 862-4667
PAYMENT Information: Payment of $365 before Jan 2nd or $390 after . Games start Jan 9th or 16th . There is a $3 charge per transaction added for credit card processing ______$75 for individual player (T Shirt included)
______ Check via Mail to "Hoop City " _____ Money Order
Credit Card (Master Card or Visa) Credit Card No. ___________________________________________ Expiration: ________
Name on It ______________________________ Credit Card Signature: _____________________________________________
Zip Code: __________________ Street address of where you receive your credit card bill.
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. I further will share this with all the parents of my players and that by your signature below, you are signing on behalf of your entire team.
Coaches Signature: _______________________________________ Date: _________________________
Mail to Hoop City - c/o PO Box 68544 - Grand Rapids, MI 49516 616-957-HOOP (4667)
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