EmailMe Form - Team Creation

Player's Name *

First Last

Players Phone

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

School

GPA

Height

Gender *

Male

Female

Grade *

Date of Birth *

MM / DD / YYYY

Guardian Information

Please enter parent or legal guardian information here

Name *

First Last

Phone *

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

Email *

Address *

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

Release of liability

Mandatory Release of Liability:  I understand that participation in Team Creation basketball programs involves risk and danger of serious and permanent injury and death. I hereby release, hold harmless, discharge and agree not to sue the Team Creation Basketball Association, League Directors, employees, volunteers, officials, coaches, captains, Owners/Lessers of the Premises for all liability from participation in these and any other Team Creation Basketball Association related activities. Authorization of Treament for a Minor  I/We, the undersigned, parent (s)/ Guardian (s) of a minor, do hereby authorize the Team Creation Basketball Association as agent(s) for the undersigned for the purpose of authorizing and signing any consents for any X-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any hospital, or to be rendered by a dentist licensed under the provisions of the Dental Practice Act, as the case may be, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which any physician in the exercise of his best judgment may deem advisable.  I/We hereby authorize any hospital, which has provided treatment to the above named minor to surrender physical custody of such minor to my/our above named agent(s) upon completion of treatment. These authorizations should remain effective until 08/31/2024  unless sooner revoked in writing delivered to said agent(s).

BY CHECKING THE BOX BELOW I HAVE READ THE ABOVE WAIVER, RELEASE, AND INDEMNIFICATION OF LIABILITY AND I UNDERSTAND THAT I AM VOLUNTARILY GIVING UP CERTAIN RIGHTS BY CHECKING IT