Please fill out completely- including zip code

Name 1: ______________________________________________ Date of Birth: _________________ Age: _______

City: ________________________________________________________ State: ______ Zip: __________________

Parent’s/Guardian’s Name: ________________________________________________________________________

Email: __________________________________________ Cell Phone: ____________________________________

Name 2: ______________________________________________ Date of Birth: _________________ Age: _______

City: ________________________________________________________ State: ______ Zip: __________________

Parent’s/Guardian’s Name: ________________________________________________________________________

Email: __________________________________________ Cell Phone: ____________________________________

Name 3: __________________________________­­­____________ Date of Birth: _________________ Age: _______

City: ________________________________________________________ State: ______ Zip: __________________

Parent’s/Guardian’s Name: ________________________________________________________________________

Email: __________________________________________ Cell Phone: ____________________________________

Name 4: __________________________________­­­____________ Date of Birth: _________________ Age: _______

City: ________________________________________________________ State: ______ Zip: __________________

Parent’s/Guardian’s Name: ________________________________________________________________________

Email: __________________________________________ Cell Phone: ____________________________________

Name 5: __________________________________­­­____________ Date of Birth: _________________ Age: _______

City: ________________________________________________________ State: ______ Zip: __________________

Parent’s/Guardian’s Name: ________________________________________________________________________

Email: __________________________________________ Cell Phone: ____________________________________

Please read the following information carefully. No child will be admitted into the 3v3 Basketball League unless either a parent or legal guardian signs this form. By signing this form, you are releasing all claims for injuries that the participant may sustain.

I agree to assume full risk and to waive and release all claims I and/or the participant may have against All star sports arena. This release also includes ASSA agents, servants and employees from any such claims resulting from injury, responsible for all personal medical insurance and that the participant’s family must cover all medical cost incurred. I also understand that every precaution is taken to protect the safety of each participant. I agree to emergency treatment by a physician or hospital in the event that the emergency contact listed cannot be reached.

Parent (or legal guardian) signature 1: _______________________________________ Date:___________

Parent (or legal guardian) signature 2: _______________________________________ Date:___________

Parent (or legal guardian) signature 3: _______________________________________ Date:___________

Parent (or legal guardian) signature 4: _______________________________________ Date:___________

Parent (or legal guardian) signature 5: _______________________________________ Date:___________