VISION BASKETBALL ACADEMY

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Player Registration Form

PLAYER INFORMATION

Head Coach's Name (of the team that you are registering for):

* First Name:

Middle Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Phone Number:

* Birthdate:

* Gender:

* Grade as of the 2018-2019 School Year:

* Age that Player will be on August 31, 2019:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* Relationship to Player:

* Email Address:

* Cell Phone Number:

Alternate Phone Number:

PARENT/GUARDIAN #2

First Name:

Last Name:

Relationship to Player:

Email Address:

Cell Phone Number:

Alternate Phone Number:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact (First & Last Name):

* Phone Number:

* Relationship to Player:

Insurance Carrier:

Policy #:

Medical Conditions - Please list below any medical conditions and/or allergies that you think we should know about::

PLAYER REGISTRATION FEE

$75 for returning players (no uniforms needed) *
$175 for new players (includes home/away uniforms) *

Registration fees include AAU membership (AAU card) and insurance for the 2018 -2019 season.

* NON-REFUNDABLE

* Registration Type:

If ordering uniforms, indicate jersey size:

Shorts size:

Select 3 Numbers (separated by a comma) in order of preference:

Some jersey numbers may have already been taken. Priority will be given to returning players.

Priority for new jersey numbers will be given to the player who submitted the registration form and payment in the order received.

Please allow at least 3-4 weeks for the delivery of custom uniforms. **

** Lead times may vary depending on season and vendors availability.

REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS RECEIVED.*

* Player will not be on the official roster until this registration form and payment are both submitted.

AGREEMENT WAIVER

I hereby waive, release and discharge any and all claims for damages for the personal injury, death, or property damage which I may have, or which hereafter accrue to me or my child, as a result of participation in basketball practices and/or basketball competitions in all its forms. The release is intended to discharge in advance, the organization (Vision Basketball Academy), it’s coaches or volunteers from any and all liability arising out of or in any way connected with my participation in said activity. Its understood that the activity involves an element of risk and danger of accidents and knowing those risks, I assume those risks. It is further agreed that this waiver, release, and assumption of risk, is to be binding on my heirs and assigns. I agree to indemnify and to hold the Vision Basketball Academy, all persons and entities associated with the (Vision Basketball Academy), free and harmless from any loss, liability, damage, cost or expense, in which they may incur as a result of death, injury or property of damage that I may sustain while participating. I also give the AAU team (Vision Basketball Academy), it’s coaches or volunteers the right to copyright and/or publish, reproduce, or otherwise use my child’s name, voice, and likeness and/or photographs, and audiovisual recordings that include my child for instruction, advertising, program website, publications or brochures, or any other lawful purpose whatsoever. I hereby agree to relinquish all rights, title and interest I may have in the finished product and waive all rights to any compensation thereof.

PARENTAL CONSENT

I hereby consent that my child may participate in the above activity, and hereby execute the above agreement, release and waiver on his behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense, which may arise or may be incurred as a result of death, injury, or property damage that said minor may sustain while participating in said activity. I further expressly acknowledges that the foregoing agreement, waiver, and release form is intended to be as broad as is permitted by the laws of the State of California and that if any portion thereof is held invalid, it is agreed that the balance notwithstanding, continue in full legal force and effect. Undersigned agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

I acknowledge that the cost to participate in Vision Basketball Academy activities is $75 per month. This monthly fee covers all gym time, practices and games each month. I agree that for as long as my child is participating in Vision Basketball activities that payments will be made by the 10th of each month.

I HAVE READ THE FOREGOING RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

I/we agree with the above *

After clicking "SUBMIT FORM", you can choose to pay via check on the next screen.

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IMPORTANT: Online Payment with credit cards is not active for this form

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Player Registration Form