SPRING BRANCH-MEMORIAL SPORTS ASSOCIATION ... - SBMSA

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					SPRING BRANCH-MEMORIAL SPORTS ASSOCIATION                                                                      2012-13 BASKETBALL REGISTRATION FORM                                              FOR OFFICE USE ONLY
PROOF OF AGE REQUIRED As of January 1, 2002, a copy of a birth certificate or passport is required as proof of age for all players participating in SBMSA activities.         Age:                Program:

Registering For:                Boys Basketball _______                     Girls Basketball _______                                                                          Fee:                      Donation:
                                                                                                                                                                              Payment:    Cash
Player Information                                                                                                                                                                        Check Signee
                                                                                                                                                                                          Credit Card (Discover, Visa, Master Card)
First Name:                                                                Last Name:                                                                 Gender: M or F
                                                                                                                                                                              #
Date of Birth:                                     Boys or Girls age on 7/31/11                                  Home Phone:            _____                                             Exp. Date
                                                                                                                                                                                           Partial Pay            Scholarship
Grade in Fall 2012:              Street Address:                                                                 City:                   State:           Zip Code:
Family Information
                                                                                                                                                                              RELEASE
Parent/Guardian #1                                                                                                                                                            I/we certify by accepting these terms and conditions that the
First Name:                                                    Last Name:                                                    Occupation:                                      applicant named has my/our permission to participate in the
                                                                                                                                                                              SBMSA sports programs (including any conditioning camps,
Work Phone:                                                    Cell Phone:                                                   Relationship:                                    skills camps, skills evaluation, and tryout sessions) and I/we
                                                                                                                                                                              assume all the risks and hazards associated with such
Parent/Guardian #2                                                                                                                                                            participation, including transportation to and from SBMSA
First Name:                                                    Last Name:                                                    Occupation:                                      activities. I/we hereby waive, release, absolve, and indemnify
                                                                                                                                                                              SBMSA's officers, directors, commissioners, managers,
Work Phone:                                                    Cell Phone:                                                   Relationship:                                    coaches, supervisors, participants, and persons transporting
                                                                                                                                                                              my/our child to and from SBMSA activities, from and against
Emergency Information                                                                                                                                                         any liability for, or claim arising out of any accident or injury to
Emergency Contact:                                                         Phone Number:                                                                                      said applicant occurring during the course of his/her
                                                                                                                                                                              participation in such activities or his/her transportation to or
Communications Information . Email:                                                                     Provide an email address of an adult or responsible older child who   from such activities including by not limited to the sole or
will check for messages regularly during the season. The size of our organization prevents us from relying exclusively on phone or mail for necessary communications.         concurrent negligence of the SBMSA, its officers, directors,
                                                                                                                                                                              commissioners, managers, coaches, supervisors, umpires,
Special Requests: Please provide additional information that SBMSA should know to better serve your child. Describe any medical conditions that the coach should be           referees, participants, and persons, participants and persons
aware of. Requests for team placement with a neighbor cannot be guaranteed, but SBMSA will take request into consideration.                                                   transporting my/our child to and from SBMSA activities. I/we
Special Requests:                                                                                                                                                             hereby also waive, release, absolve, and indemnify any
                                                                                                                                                                              trainers, instructors, coaches, and organizations engaged by
Player Clinic:   Player Clinic ($5 Fee) to be held at Spring Branch Education Center on December 1, 2012?                                 YES       or      NO               SBMSA (regardless of whether paid by SBMSA) to assist with
                                                                                                                                                                              or operate any SBMSA sports program, conditioning camp,
Additional Questions
                                                                                                                                                                              skills camp, skills evaluation, or tryout session, from and
   Play Basketball in SBMSA last year? _______ Name of team or coach? ______________________________                                                                          against any liability for, or claim arising out of any accident or
  How many seasons have you played organized basketball? _____ How many seasons have you played SBMSA basketball? _____                                                       injury to said applicant occurring during the course of his/her
                                                                                                                                                                              participation in such activities.
   Is this player playing on another organized sport team during basketball season? _______                                                                                   I/we certify that it is understood that my payment is an
 Are there known schedule conflicts with SBMSA practices or games? _____ If yes, please explain _____________________________                                                 enrollment fee only and the registrant will be assigned to a
                                                                                                                                                                              team determined by the SBMSA at its sole discretion.
School Attending                                               What public elementary school serves your area?                                                                I/we authorize the coaches of my child's team to act for me
                                                                                                                                                                              according to their best judgment in any emergency requiring
Basketball Registration Fees                                                                                                                                                  medical attention.
5 – 6 years = $125                   7 -8 years = $130                    9 – 10 year olds = $140                          11 – 13 year olds = $150                           I have read, understand, and accept these terms and
                                                                                                                                                                              conditions.
Volunteer Tasks
SBMSA is a volunteer-based organization and depends on your support. If you cannot volunteer, you are encouraged to donate money to help with financial assistance for        Signature of Parent
needy participants and our capital improvements. For more information call (281) 583-3600.
             Head Coach                                      Assistant Coach                                  Team Parent                         Picture Day             Date
             Assist with Fund Raising                        Assist with Skills Assessment                    Team Sponsor                        Opening Day

NO REFUNDS after the close of registration on Wednesday, October 31, 2012. All refunds prior to that date will be subject to a $20.00 administrative fee.
Refunds can be obtained by emailing sbmsa.office@gmail.com.

				
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