EmailMe Form - Titans Basketball Registration

Player's Contact Email *

Indicate what email address should be used for communicating with Titans Basketball.

Are you a current Titan member?

Yes

No

Player's Name *

First Last

Player's Date of Birth *

MM / DD / YYYY

Player's Current School

Player's Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Player's Home Phone *

### - ### - ####

Player's Emergency Contact Number *

### - ### - ####

Parent/Guardian's Name *

First Last

Alternate contact (Other than parent) to notify in case of emergency: *

First Last

Alternate Emergency Contact Number *

### - ### - ####

Do you need a uniform? *

Yes

No

*** Select a size only if ordering a uniform. ***

Player's Jersey Size

*** Select a size only if ordering a uniform. ***

Player's Shorts Size

Player's Height (Feet & Inches, Ex: 5'-2")

Player's Weight (in pounds)

Have you ever played in a League or Team before

Yes

No

If yes above, please indicate the name of your previous Team and/or League

Reason for leaving your previous team/league:

Are you (or your spouse) interested in being a coach volunteer? *

Yes

No

* If yes, please fill out the Titans Volunteer Form also found on our website and forward it to titans.basketball@att.net

Health Insurance Carrier *

Policy Number *

TERMS AND CONDITIONS

*

Review

TITANS BASKETBALL

RELEASE OF LIABILITY/ASSUMPTION OF RISK/INDEMNITY:

Participation in Titans Basketball and use of it's premises, services, equipment and facilities involves the risk of injury to you or your child, whether you or someone else causes it. Specific risks vary range in severity from minor injuries to major injuries, such as catastrophic injuries including death. In consideration of you and/or your child's participation in the activities or program offered by Titans Basketball, you understand and voluntarily accept this risk and agree that Titans Basketball, its officers, directors, employees, volunteers, agents, property owners and independent contractors will not be liable for any injury, including, without limitation, personal, bodily, or mental injury, economic loss or any damage to you or your minor child resulting from the negligence of Titans Basketball or anyone on Titans Basketball’s behalf or anyone else whether related to participation in Titans Basketball program or not. You understand and acknowledge that Titans Basketball is providing recreational services and may not be held liable for defective products.

You understand that you and/or your child(ren) may be photographed, videotaped, or otherwise recorded, and you agree on behalf of yourself and/or your child(ren) that Titans Basketball may use your and/or your child(ren)’s name and likeness (in any form and without regard to distortions of character, form or color, or any other alteration) in photographs, videotapes, audiotapes, and other media, without any additional consideration to you and/or your child(ren) or to any third party.

By signing below, you agree to the terms of this Release of Liability and Assumption of risk on behalf of yourself and your child. You also represent that you are the parent or legal guardian of the program participant for which this application is being prepared. You also agree to defend and indemnify Titans Basketball from and against any claims, demands, causes of actions or lawsuits brought by the child or on his or her behalf for injuries or other damage whether or not caused by the negligence or other conduct of Titans Basketball.

CANCELLATION AND REFUND POLICY

As basketball leagues/clubs are required to pay for all associated fees (i.e. gym rentals, league fees, insurance, uniforms, etc.) before the session begins, there are no refunds that will be paid out to player(s) once registration is paid to the Titans organization.

Do you agree with terms and conditions? *

Yes, I agree

Initial *

Today's Date *

MM / DD / YYYY