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:
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:
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,
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
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 firstname.lastname@example.org.