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Individual - 2025 Winter Youth and High School Basketball League Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Address:

* City:

* State:

* Zip Code:

* Primary Phone Number:

* Re-Enter Primary Phone Number:

* Email:

* Re-Enter Player Email:

* Birthdate:

* Age:

* Position:

* Height:

* Gender:

* School:

* Grade:

* Any Medical Conditions, Allergies, Comments, etc.:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* Email:

* Re-Enter Email:

* Primary Phone Number:

* Re-Enter Primary Phone Number:

PARENT/GUARDIAN #2

First Name:

Last Name:

Email:

Re-Enter Email:

Primary Phone Number:

Re-Enter Primary Phone Number:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Primary Phone Number:

* Relationship to Player:

Insurance Carrier:

Policy #:

I hereby authorize and guarantee payment for all deposits and services rendered. I understand that payment is non-refundable after league start date. In the event that my account becomes delinquent for more than 30 days, I understand that I will be charge a $20 late fee. I also agree to pay a finance charge of 1.5% per month on any balance due, as well as all collection costs, court costs, attorney fees and interest fees accrued with the collection of this account.

WAIVER INFORMATION

North Eastern Basketball Association, L.L.C.

Amateur Athletic and Minor Waiver and Release of Liability

In consideration of being allowed to participate in any way in the North Eastern Basketball Association, L.L.C. athletics/sports programs, and related events and activities, the undersigned:

1. Agree that the parent(s) or legal guardians(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate. In the case of an Adult he/she assumes all risks of play and conditions upon participating.

2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only for their own actions, inactions, or negligence but the actions, inactions, or negligence of others, the rules of play, or the conditions of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. Assume all the foregoing risk and accepts personal responsibility for the damage following such injury, permanent disability, or death.

4. Release, waive, discharge and covenant not to sue North Eastern Basketball Association, L.L.C., it's affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owner and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releases", from any and all liability to each of the undersigned, his and her heirs and the next of kin for any and all claims, demands, losses, or damages on account of injury, including death or damage to property, caused or alleged to be causes in whole or in part by the negligence of the releases or otherwise.

5. North Eastern Basketball Association, L.L.C., it's affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owner and leasers of premises used to conduct the event, cannot prevent your player from becoming exposed to, contracting, or spreading COVID-19 while utilizing releases services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize releases services and/or enter onto releases premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

I Have Read The Above Waiver and Release, Understand That I Have Given Up Substantial Rights By Signing It and Sign It Voluntarily.

I Have Read The Above Waiver and Release and I/we agree with the above *

* Parent/Guardian's Signature:

Parent/Guardian's Signature:

North Eastern Sports is a Division of North Eastern Basketball Association L.L.C.

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