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IHA ADULT OPEN RUN
REGISTRATION FORM
Please fill out the form below to participate in the ADULT Open Run
ADULT BASKETBALL REGISTRATION, WAIVER, FORM
*
Indicates required field
Name
*
First
Last
The undersigned hereby agrees to indemnify and hold harmless IN HOUSE ATHLETICS coaching staff, organizers, fellow players and anyone affiliated to IHA. from any loss, damage or injuries incurred by the undersigned of any facilities, programs or activities owned, maintained or supervised by agents or employees of IHA.
EACH PLAYER MUST COMPLETE HIS OR HER PORTION OF THE REGISTRATION/WAIVER FORM
In Signing below, I verify to play in the mentioned activity that in consideration of your accepting the entry. I intend to be legally bound hereby for myself, my heirs, executors and administrators, waive and release any and all rights I may have against In House Athletics, organizers, fellow players and their representatives for any and all injuries suffered by me at the activity
EACH PLAYER MUST HAVE A COPY OF THIS FORM ON FILE IN ORDER TO PARTICIPATE IN IHA ACTIVITIES
EVENTS ARE INVITE ONLY. UNINVITED PLAYERS WILL NOT BE ALLOWED TO PARTICIPATE
Initial
*
PLayer Name
*
First
Last
Phone Number
*
Email
*
Method of Payment
CashApp
Cash Tag
*
Venmo
Venmo Username
*
PayPal
PayPal Username
*
Other
Other Username
*
COST TO PLAY IS $8 PER PARTICIPANT
Payment is needed in order to continue to using the gym.
Payment request will be sent to you once we confirm participation.
PAYMENT IS DUE 2 HOURS BEFORE EACH SCHEDULED EVENT
IF PAYMENT IS NOT RECEIVED BY REQURIED TIME, ENTRY WILL BE FORFIETED TO ALLOW OTHER PARTICIPANTS
Three missed payments and you will not be invited back.
PARTICIPANTS WILL BE LIMITED TO 15 PLAYERS PER SESSION
IN HOUSE ATHLETICS
Emergency Contact
Name
*
First
Last
Phone Number
*
Relationship
*
Comments/Questions
*
MEDICAL WAIVER
Liability Waiver
: Basketball presents certain inherent risks and hazards, which the Player-participant and parent/guardian are urged to consider and which the Player assumes. To the best of my knowledge, there are no physical or other health-related conditions, which will interfere with my child’s participation unless noted above.
I, the undersigned parent/guardian for the above named Player, understand and acknowledge that such recreational activities have inherent risks, dangers and hazards, foreseeable and unforeseeable, that may result in injury, illness, or property damage, and on behalf of myself, my family, agents and contractors, I hereby release and agree to hold harmless In House Athletics, it sponsors and its coaches, managers, club officers and directors, from all claims, actions, or losses related thereto. In House Athletics, assumes no liability for injury or damage arising from the results of participation of the above Player unless due to willful fault or gross negligence on the part of In House Athletics I also agree that my child will be a registered AAU member with Added Benefit Insurance coverage.
Medical Treatment Release
: Due to the strenuous nature of basketball, the Player participant is urged to consult her physician concerning her fitness to participate. I, the undersigned parent/guardian for the above named Player hereby approve of my child’s participation in In House Athletics program and consent to emergency medical treatment for my child on my behalf. I also authorize any representative of In House Athletics to obtain any necessary medical treatment for my child on my behalf, in case of an emergency, where I am not present and with the understanding that I will be notified as soon as possible. My health insurance information has been provided above.
Name
*
First
Last
Date
*
Submit
618-691-7680 |
[email protected]
