*Please arrive 30 min. prior to start time to complete registration*

Have “player”WEAR TENNIS SHOES

Monday - November 17, 2014
GIRLS: 3rd & 4th Grade –6:30pm to 7:15pm
GIRLS: 5th & 6th Grade –7:30pm to 8:15pm / Tuesday - November 18, 2014
BOYS: 3rd & 4th Grade –6:30pm to 7:15pm
BOYS: 5th & 6th Grade –7:30pm to 8:15pm
  • “Participation / Instructional” league
  • Games played on Saturdays and possibly Sundays – starting the 1st Saturday in January after students have returned to school from holiday break
  • Practice one to two nights a week
  • Team jersey included in registration fee
  • Registration fee - $55.00 per player (additional family members - $40.00)
    Money due at Registration / Skills test.
  • Make Check payable to: Piper Optimist

Player’s Name (please print):______

Current Grade:3rd 4th 5th 6th Boyor Girl(circle one)

Jersey size for player:Youth: M LAdult: S M L XL

Parent/Guardianname(s) ______

best Phone #for parent/guardian to be contacted at:______

Parent/guaridaneMail address: ______

Please write EXACT Time(s) your child absolutelycannot practice next to the day of the week below(practices will be 1 hour, 1-2 times per week, starting no earlier than6:00 pm and ending by 9:30 pm)
Mon ______Tues ______Wed ______Thur ______Fri ______

RELEASE OF LIABILITY

FOR INJURY and MEDICAL COSTS

The undersigned player and parent/guardian, in the consideration of the player being permitted to participate in the Piper Optimist Basketball league, do hereby release and forever discharge the sponsors, schools, officials, and any directors from any and every claim, demand, or right of action arising from or by reason of any bodily injury resulting or which may occur as a result of participation in the basketball activity.

The undersigned specifically acknowledges that they and not the sponsors or coaches are responsible for the cost of all health care and/or medical treatment required as a result of injuries received during participation in the basketball activity.

The undersigned further releases the sponsors, schools, officials, and any directors from any claim whatsoever on account of first aid, treatment or service rendered during participation in the basketball activity.

This release contains the entire agreement and its contents have read by the undersigned and they know the contents.

In witness whereof, releaser has executed this release on this

______day of ______, ______.

______

(player)(parent/guardian)

Parent/Guardian,

Take note that you are responsible for siblings/friends and YOUR own actions during practices and games. Please do not let siblings/friends become involved in careless acts that may result in injury (i.e. climbing on walls, sliding down stair rails, jumping off bleacher seats, etc.) or intentional damage to the facility (i.e. clogging toilets). Please refrain from abusive / non-supportive language or actions while in the gym. The Piper Optimist maintains the right to request YOU to leave the premises and/or to not allow YOUR child to participate.

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