Coach Randy Holmes Basketball Club, Inc
TEST-Jefferson
First Name:
Phil
Father's Name:
Mother's Name:
Last Name:
TEST-Jefferson
Father's Phone #:
Mother's Phone #:
Birthday:
Height
Parent /
Guardian E-Mail:
Street Address:
City:
I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules and regulations of the Team Swish Basketball Program. Recognizing the possibility of physical injury associated with basketball. I hereby release, discharge and/or otherwise indemnify Team Swish Basketball Program, Its officials, coaches, referees and all other persons entities involved WO team/program operations, against any claim by or on behalf of the registrant as a Result of the registrant participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.
State:
State:
I agree to the terms above
Zip Code:
School Name:
Grade as of
September:
Parent / Legal
Guardian Name:
Date Agreed