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 Leo Baker , 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: Tarah Baker Father: Nick Baker or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-405-7115 MOM 937-408-2412
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Leo Baker 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: Tarah Baker Father: Nick Baker 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 Brayden Dailey , 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: Father: Khaliel Dailey or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9372505708 MOM
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Brayden Dailey 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: Father: Khaliel Dailey 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 Murilo De Oliveira , 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: Deisy Oliveira Father: Edwilson Oliveira or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9379013806 MOM 9372039798
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Murilo De Oliveira 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: Deisy Oliveira Father: Edwilson Oliveira 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 Miguel De Oliveira , 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: Deisy Oliveira Father: Edwilson Oliveira or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9379013806 MOM 9372039798
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Miguel De Oliveira 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: Deisy Oliveira Father: Edwilson Oliveira 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 Chance Hudgins , 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: Heather Davis Father: Joey Hudgins or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-830-1203 MOM 937-313-9989
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Chance Hudgins 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: Heather Davis Father: Joey Hudgins 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 Griffin Leach , 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: Melissa Leach Father: Ryan Leach or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 6142182299 MOM 9373696790
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Griffin Leach 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: Melissa Leach Father: Ryan Leach 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 Hunter Molchan , 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: Heather Molchan Father: Michael Molchan or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9372727203 MOM 9378230411
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Hunter Molchan 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: Heather Molchan Father: Michael Molchan 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 Caleb Morter , 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: Casey Morter Father: Josh Morter or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-684-7910 MOM 937-241-5146
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Caleb Morter 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: Casey Morter Father: Josh Morter 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 Jamonn Russell , 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: Ashley Russell Father: Jamonn Russell or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-759-5492 MOM
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Jamonn Russell 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: Ashley Russell Father: Jamonn Russell 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 Michael Speed II , 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: Whitney Speed Father: Michael Speed or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-815-5021 MOM 937-477-2099
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Michael Speed II 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: Whitney Speed Father: Michael Speed or Guardian: _______________
--> Signature ______________________________________________ Date _______________