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Player Name (or team name) _______________________________ Date of Birth: _______________
Address ______________________________ City ___________________ St _____Zip __________
Phone (Home) _________________ (Work) _______________ Email ________________________
Current Grade: _______ Male _______ Female ________ Ht. _____ Position __________________
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. There is a $3 charge per transaction added for credit card processing
______ Personal Check via Mail ______ Money Order
Credit Card (Master Card of Visa) Credit Card No. _____________________________________ Expiration: ________
Name on CC ______________________________ 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: _________________________
Mail to Hoop City - c/o PO Box 68544 - Grand Rapids, MI 49516 616-957-HOOP (4667)
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