Hoops & Stars, Inc. Basketball ~ 2017
Central Orange County Registration
Season Opens Saturday, January 14, 2017 Players must be 12 by January 1, 2017
Please list only one player per form Returning Player ______New Player ______
Player Name: ______Date: ______
Birthdate: ______Sex: F M School/Program: ______Age: ______
Address: ______City & Zip Code______
Home Phone: ______E-Mail Address: ______
Wheelchair: Walker: T-Shirt Size: ADULT: S M L XL XXL XXXL
Emergency Contact: ______Phone#:______
Father/Guardian ______Mother/Guardian ______
Phone Number ______Phone Number______
Cell Number ______Cell Number ______
E-Mail Address ______E-Mail Address ______
HoopStars is run by volunteers. We appreciate your willingness to help so that the league can operate. Please check one of the activities below
to indicate what you would like to do to help.
____ Coach ____ Asst Coach ____ Team Parent ____ Referee ____ General Volunteer ____ Court assistance ____ Scorekeeper
Liability Waiver: I (Parent/Guardian in the case of a dependent) acknowledge that Hoops and Stars, Inc., (herein after referred to as HoopStars) will use and display photographs and videos of the above named player taken at games and other HoopStar related events in publications, multimedia productions, displays, advertisements and World-Wide Web Publications. The undersigned assumes all risks and hazards incidental to the participation in this sports program, including transportation to and from such activities, and does hereby release and waive any and all claims or actions for damage or injury of whatever kind against HoopStars, its volunteers and/or participants, or any venue that may be used for activities, including but not limited to West Anaheim Youth Center, arising from any activities or actions of this sports program. I further grant permission for emergency first aid to be given to me (or this minor/adult) and to be taken to the emergency room of a nearby hospital in the event of serious injury. Permission is granted to the hospital and its staff to provide any treatment that the physician deems necessary for my wellbeing (or that of this minor/adult). I understand that I will be held financially responsible for any HoopStars property (e.g. jerseys) that are not returned at the end of the season.
NOTE: In the event that any player is not picked up within 15 minutes of the end of the last game, practice or other HoopStars events the local authorities have agreed to offer their assistance.