2016 HangTime Registration Form

Hangtime Basketball League - Registration Form

3rd & 4th Grade Tues. starting Oct. 18th.

1st & 2nd Grade Thurs Starting Nov. 3rd

Skybacher Ministries Inc.

www.skybacherministries.org

Athlete Information

Player Name*

First NameLast Name

Grade Registering For.

1st Grade (Thurs. starting Nov. 3rd).2nd Grade (Thurs. starting Nov. 3rd)3rd Grade (Tues. starting Oct. 18th)4th Grade (Tues. starting Oct. 18th)

Homeroom Teacher

Additional Child

First NameLast Name

Grade Registering For.

1st & 2nd Grade (Thurs. starting Nov. 3rd).3rd & 4th Grade (Tues. starting Oct. 18th)

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Important Notes

· Students should bring gyms clothes to change into.

· Water Bottle

· Snack for after-school.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Please describe*

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at Skybacher Ministries Inc. may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Skybacher Ministries Inc. and the persons in charge.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form. You will receive a confirmation email with a link for you to complete the Stay After School Permission Form.

If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at skybachermi@gmail.com

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