81 North Classic Events

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College Coaches Registration For The FBC Holiday Classic

COACHES INFORMATION

* Coach 1 (First Name & Last Name):

Coach 2 (First Name & Last Name):

Coach 3 (First Name & Last Name):

* Division Level:

DII

DIII

NAIA

JUCO

* School Your Repersenting:

SCHOOLS ADDRESS

* Day/Days you be attending:

* Street:

* City:

* State:

* Zip Code:

* 1st Coach Cell Phone:

* 2nd Coach Cell Phone:

* 3rd Coach Cell Phone:

* Email:

* Work Phone:

* Work Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

As a College Coach I realize the risk of injuries involved in the game of basketball, and agree to hold harmless 81 North Classic Events or Davis College, along with staff for any and all injuries I my incurred while I am attending this event.

In addition, I agree not to pursue any claims for accident or injury against any other group or organization providing practice facilities or equipment for 81 North Classic Events or Davis College. I further recognize that I must first file a claim with my primary health insurer to be eligible for benefits from the sanctioning bodies. I also agree to be photograph as well as allow my name to appear in any films, program, news paper, website etc. that has to do with FBC Holiday Classic or 81 North Classic Events! THIS PURCHASE IS NONREFUNDABLE.

I/we agree with the above *

* indicates required fields

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

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College Coaches Registration For The FBC Holiday Classic