Confidential Player Information

Player Full Name

Jersey Size

Small              Medium   Large

Grade 

6th                  7th           8th     9th    
Position Point Guard   Guard      Post

Level of  Experience

House            Select      AAU 
Yrs. of Experience
AAU or Recreation Team
AAU or Recreation Team Coach 
 Coach Email Address
   

Contact Information

Parent or Guardian: Required

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Primary Phone #1 Cell Home Office
Alternative Phone #2 Cell Home Office
Fax

Please enter your email address: Required

Medical Information

Any allergies or medical condition

No    Yes (Explain below)
If yes explain
Athlete's Physician 
Address
Phone Number
Medical Insurance Company Name
Policy #

I hereby release and waive VA Elite Hoops staff members from any liability for injuries and illness incurred as a result of participation in the tournament.

Due to the strenuous nature of some activities, the participant is urged to consult his/her physician concerning ability to participate. 

I am or my child, is able and willing to attend the VA Elite Hoops and Basics 1st certify that I, or my child to the best of my knowledge, has no physical or other condition that will interfere with my or my child’s participation.  I give my approval to the participation in any and all of the activities of VA Elite Hoops and Basics 1st including but not limited to, games, if any.

I authorize the gym staff to act on my behalf regarding any injury or health problem occurring while I am or my child is attending the tournament.  VA Elite Hoops and Basics 1st has my permission in case of emergency to call Emergency 911 and/or send me or my child to a hospital or Urgent Care Facility.  The medical staff of these institutions has my authorization to provide treatment, which a Physician deems necessary for the well being of myself or of my child. 

I hereby release and waive VA Elite Hoops and Basics 1st staff members from any liability for injuries and illness incurred as a result of participation in the tournament

Authorization and Approval

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