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Dublin Panthers Registration
PLAYER INFORMATION
*
First Name:
*
Last Name:
Street:
City:
State:
Zip Code:
Home Phone:
Birthdate:
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Email:
Gender:
M
F
Grade:
K
1
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PARENT/GUARDIAN #1
Firstname:
Lastname:
EMail:
Home Phone:
Work Phone:
Cell Phone:
PARENT/GUARDIAN #2
Firstname:
Lastname:
Email:
Home Phone:
Work Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact:
Phone:
Relationship to Player:
Insurance Carrier:
Policy #:
WAIVER INFORMATION
Parent's Consent and Waiver:
I hereby give my consent for my child to participate in all Dublin Panthers activities. I agree to allow the coaches to place my child on the Dublin Panthers team their evaluation says they belong on. I understand basketball can be a physically demanding and dangerous sport. I declare my child is in good physical condition and is able to meet these physical demands. I hereby give the staff of Dublin Panthers Basketball as well as officials of any event we attend permission to render such medical and hospital care as, in their judgement, may seem advisable for my child. I also hereby state we have adequate medical and dental coverage and will not, under any circumstances, hold the staff or organization of the Dublin Panthers liable for any injuries incurred during practice or league or tournament play.
I/we agree with the above
*
Dublin Panthers REFUND POLICY:
I/we understand that no Spring refunds will be given after March 1st, 2019, No Summer Session refunds will be given after June 1st, 2019, No Fall session refunds will be given after September 1st, 2019, and no Workout, Camp or Skills clinic refunds will be given after the first workout of said program. I/we also understand that refunds requested before the above listed cutoff dates will be given less a $50 service charge.
I/ we further understand that single session refunds on multi-session pre-payments will be given if requested before the above cutoff dates for the session in question; but the refund will be adjusted so as to forfeit the multi-session discount plus a $50 service charge. I/we also agree to a $25 returned check fee.
By Checking this box, I/ We agree with the above
*
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