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Complete and sign below, then send in using the mailing address below:
Team Name _________________________________________________ Age or Grade Level:_______________ Circle the Date Above
Coach's Name:______________________________________ Asst Coach name_______________________ Asst phone ______________________
Address __________________________________________ City _________________________ St _____ Zip __________
Head Coach Phone (Home) ___________________ (Work) ___________________ Email (Mandatory) ____________________________________
PAYMENT Information: Payment of the team or individual must be done at the time it is mailed in of by attaching credit card information below.
______ Check via Mail ______ Money Order Credit Card (Master Card of Visa) Credit Card No. __________________________________ Expiration: ________ note: the address above must match the billing address for the credit card. Exact name on the card ______________________________ Credit Card Holder Signature: _____________________________________________
Permission and Liability Waiver
Each player on your team will need to have completed a roster form with our Permission & Liability Waiver form. We will email you the form once we receive your payment and this registration form. The Permission and Liability form gives permission to your team members and coaches to participate in the event you circled or listed above. As head coach, you further understand that participation is such activities may cause injury to your players just by the nature of the activity. Until the fully completed Permission and Liability Waiver is turned in, you will personally take full responsibility for any injuries suffered by any player or coach on your team and will hold Hoop City Basketball. LLC, Jenison Basketball Partnership, LLC, the partners of such, East Hills Athletic Center, their respective staffs harmless for any injury, loss or damage if you choose not have individual signed waiver form of each athlete and coach on your team. You further assure that your players/coaches have no health problems that would prevent them from full participation in the activities involved in the event they are registering for. I will be solely responsible for my teams safety and have fully inspected the courts/facilities used for the event. 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, Jenison Basketball Partnership, LLC, its sponsors, East Hills Athletic Center, any 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 read and fully understand the above Permission and Liability Waiver and agree to abide by it.
Head Coach Signature: __________________________________________________Print Name: _________________________ Date: _________________________
Schedules will be emailed to you and posted on the web site link we will send - Email: hoopcitymgr@sbcglobal.net MAIL REGISTRATION FORMS & PAYMENT: c/o Hoop City Basketball, PO Box 68544, E. Grand Rapids, MI 49516
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