St Clements/St. Peters CYO Basketball (2017/2018)
Registration Form
Please complete and return form to the St. Clement’s Parish Center prior to October 9, 2017.
Address Questions To:
Player assessment dates will be October 14, 2017 – Saint Clements School Gym.
Biddy boys (grades 5/6) 12:00 PM - 1:30PM
Junior boys (grades 7/8) 2:00 PM - 3:30PM
Girl’s times will be determined after 10/9/17 depending on level interest.
Player name (full): ______(M) (F)
Parent/Guardian Name(s) ______
Address: ______
Telephone: ______Cell Telephone: ______
Email: ______Secondary Email: ______
Date of birth ______Age (As of 9/1/17) ______Grade (As of 10/1/17) ______
Returning Player ( ) Yes ( ) No
Catholic ( ) Yes ( ) No
Parish: ______
Emergency Contact name and telephone number: ______
Fee: Single player $185.00 ( ) paid ( ) Check #______
Two players $360.00 ( ) Third player $400.00 ( )
Please make checks payable to “St. Clements CYO Basketball”. Apologies – No cash Credit cards accepted – contact Randy Rivers
Volunteer opportunities (*Virtus Training required – 2 hour class): Please check - Coach* ( ) Assistant Coach* ( ) Team Parent*( ) Score Keeper ( )
NO GUARANTEED TEAM PLACEMENT.NO REFUNDS AFTER TEAM ASSIGNMENTS ARE MADE.
Waiver and Release of Liability: Read Before Signing
In consideration of being allowed to participate in any way in the St. Clement’s/St. Peter’s 2017/2018CYO Basketball Program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: The risk of injury from the activities involved with this program are possible, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of injury does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Releases of others, and assume full responsibility for my child’s participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, my child or I observe any unusual significant hazard during our presence or participation, we will remove ourselves from participation and bring such to the attention of the Releases immediately; and I, for myself and on behalf of my child, heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, and hold harmless St. Clement’s Regional Catholic School in Saratoga Springs New York; St. Clements Roman Catholic Church in Saratoga Springs, New York;The Church of St. Peter in Saratoga Springs, NY; Saratoga Central Catholic in Saratoga Springs, NY; Roman Catholic Diocese of Albany, New York; employees; coaches; volunteers; officers; directors; successors; and assigns; and any and all sponsors; their representatives and successors (“Releases”), with respect to any and all injury, disability, death, or loss or damage to person or property associated with my child’s and my presence or participation, including the aggravation of any preexisting personal conditions of my child’s that may exist, whether I am aware of them or not, whether arising from the negligence of the Releases or otherwise, to the fullest extent permitted by law. I attest and verify that my child is physically fit, that a licensed medical doctor has verified my child’s condition, and that he/she may safely participate.
I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS.
Signature of Parent/Guardian ______Date______