Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Ashton Adams , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Adrienne Father: Matt or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-231-2696 MOM 937-238-1417
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Ashton Adams fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Adrienne Father: Matt or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Daniel Braun , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Holly Father: Todd or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-479-0981 MOM 937-361-2902
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Daniel Braun fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Holly Father: Todd or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Ned Bruzzese , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Emily Bruzzese Father: Tony Bruzzese or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-474-2967 MOM 937-474-2964
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Ned Bruzzese fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Emily Bruzzese Father: Tony Bruzzese or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Carson Dewald , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Kelly Dewald Father: Mark Dewald or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-620-6934 MOM 937-620-9502
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Carson Dewald fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Kelly Dewald Father: Mark Dewald or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Eli Edwards , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Jenny Father: Matt or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD MOM 937-321-4975
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Eli Edwards fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Jenny Father: Matt or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Josiah Hargrave , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Letitia Father: Jerod or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 267-971-7919 MOM 267-971-6577
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Josiah Hargrave fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Letitia Father: Jerod or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Liam Harkenrider , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Kathryn Father: Andrew or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-414-5857 MOM 937-510-3319
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Liam Harkenrider fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Kathryn Father: Andrew or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Nico Mastro , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Nicole Mastro Father: or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD MOM 937-479-5985
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Nico Mastro fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Nicole Mastro Father: or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Vincent Seaton , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Lyndsay Seaton Father: Dan Seaton or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-478-7790 MOM 937-478-8112
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Vincent Seaton fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Lyndsay Seaton Father: Dan Seaton or Guardian: _______________
--> Signature ______________________________________________ Date _______________
3rd Grade Boys Blue
Kettering Basketball Club Consent Form
PLEASE READ AND SIGN BOTH THE MEDICAL RELEASE AND FAMILY MEMBERSHIP AGREEMENT BELOW
Release Agreement for Minor
I, the undersigned, being the parent and/or legal guardian of Jaion Walker , a player in the Kettering Basketball Club who is a minor, do hereby understand fully the risks associated with participating in this activity and in consideration of accepting my child for the Kettering Basketball Club and it's programs, do hereby release, discharge and/or otherwise indemnify the Kettering Basketball Club, all it's administrators, coaches, volunteers and associated personnel, against any claim by or on behalf of my child as a result of his/her participation in the Kettering Basketball Club, including being transported to or from Club activities for which I gave verbal or written authorization.
Furthermore, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent named above.
Finally, in my absence I, the undersigned, as the parent and / or legal guardian of my child, do hereby give my consent for the transport of the above named minor, for the purposes of Medical Treatment, and / or Scheduled Practices and / or Games; by his/her coaches.
Mother: Jaclyn Stinson Father: or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD MOM
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Jaion Walker fully understand that the following seven items are conditions of my child be accepted into and participating in the Future Firebirds Basketball Program:
1. I must maintain his/her entire uniform throughout the entire season and realize that if I lose or destroy any part of it, that I must immediately pay $25 per individual item to replace it.
2. I am financially responsible for any bank charges that the Club might incur because of my giving the Club a check that does not immediately clear my account..
3. I realize that regardless of how many games or minutes my son/daughter actually participates in or his/her team plays; there will be absolutely NO refunds of any portion of the player participation fee.
4. While at any Club function (games, practices, meetings, etc.) our entire family unit must always conduct ourselves in a manner consistent with the club's spirit of integrity, decency, and fair play and in conformance with the Metro Behavioral Code of Conduct that each player and parent is required to read and sign..
5. I understand that none of my other children may be in the school building during my child's practices and young children must be supervised at games.
6. I understand and accept that the Club has no tolerance for parental misbehavior. If a player has an adult relative ejected from a game by an official, that adult will no longer be permitted to attend home games. On the 2nd family offense, player will be expelled from the Club – no refunds will be made. Also, if a relative is found "coaching" from the sidelines, they will be asked to leave the game. Please allow the coaches to be the only voice of instruction during the games.
Mother: Jaclyn Stinson Father: or Guardian: _______________
--> Signature ______________________________________________ Date _______________