Youth Hornets Basketball

Parent / Guardian Information

Parent / Guardian Name:*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Work Phone*

Email*

Enter Email Confirm Email

Player #1 Information

Player' #1 Name*

First Last

Player #1 Registration Fee*

Price:

Player #1 Grade*

Player #1 Gender*

Player #1 Birthdate*

Player #1 Age*

Player #1 Height*

Player #1 Weight (lbs)*

Player #1 Uniform Size:*

Player #1 School*

Would you like to register another player?*

Yes

Player #2 Information

Player' #2 Name*

First Last

Player #2 Registration Fee*

Price:

Player #2 Grade*

Player #2 Gender*

Player #2 Birthdate*

Player #2 Age*

Player #2 Height*

Player #2 Weight (lbs)*

Player #2 School*

Player# 2 Uniform Size:*

Would you like to register a third player?*

Yes

Player #3 Information

Player' #3 Name*

First Last

Player #3 Registration Fee*

Price:

Player #3 Grade*

Player #3 Gender*

Player #3 Birthdate*

Player #3 Age*

Player #3 Height*

Player #3 Weight (lbs)*

Player #3 School*

Player# 3 Uniform Size:*

Jr. Hawks – Uniform Sizing Chart

When choosing your uniform size, we recommend ordering one shirt size larger.

Volunteer Information

Would you like to Volunteer?*

YES

Choose from Any of the Following:

Head Coach

Assistant Coach

Team Manager

Insurance Information

Name of Insured*

Insurance Policy #*

Insurance Company Name*

Insurance Group #*

General Release, Waiver of Liability & Hold Harmless Agreement

That (Parent/Guardian) hereby agrees to indemnify and hold harmless the Hiram Youth Basketball Association, HBBC Board of Directors, Hiram HS and the Paulding County School District against any and all liability, loss, damages, costs, rights and causes of action of whatsoever kind and nature, specifically including, but not limited to, bodily and personal injuries of the undersigned or (Player Name #1,2,3) as their minor child, as well as all hospital bills, doctor bills, drug bills, and other medical expense, general and punitive damages, that may result from any incident occurring while en route to or from, or while on the premises of the facilities used by Hiram Booster Basketball Club. It is expressly agreed that the undersigned fully understands that the execution of this document will prevent the undersigned or (Player Name #1,2,3) their minor child, from asserting any claim as set forth herein, sustained while on the premises or en route to or from said premises. I hereby give permission for my child to obtain medical care by medical professionals. Additionally, I give permission for transportation to a medical care facility if required.

Parent / Guardian Name:*

First Last

Player' #1 Name*

First Last

Player' #2 Name*

First Last

Player' #3 Name*

First Last

Parent / Guardian Consent*

I agree with and consent to all terms

Date*

Signature Required

Practice Policy

I understand and agree that practices for all age groups (K-12th) is closed. Closed practices will only include designated/authorized coaches and players only. Parents, Guardians, or Siblings will not be permitted participate or remain in the designated gym during practice time(s).

Parent / Guardian Consent*

I agree & consent to all terms of the Practice Policy

Refund Policy

100% within 5 business days. After 5 business days 0% refund will be issued.

Parent / Guardian Consent*

I agree & consent to all terms of the Refund Policy

Payment Center

Please note: there is a PayPal processing fee included with each payment(s).

After filling out your registration information , click Submit and you will be taken to a secure PayPal payment page where you can either pay using your PayPal account or your credit/debit card. The name of the merchant will appear as Hiram Basketball Booster Club. Payment is due upon registration.

Once your payment is completed, you will need to click on the link that says Go Back to Hiram Youth Basketball

Total

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name