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  Saif Aljanabi , 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:  Sally   Father:  Hyder         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 9374098780  MOM 9373290696

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Saif Aljanabi 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:  Sally   Father:  Hyder         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  JD Cunningham , 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:  Jill Cunningham    Father:  John Cunningham         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 937.901.0062  MOM 937.307.6855

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   JD Cunningham 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:  Jill Cunningham    Father:  John Cunningham         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  Miles  France , 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:  Brooke    Father:  Sean         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD   MOM 9377893830

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Miles  France 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:  Brooke    Father:  Sean         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  Quinn Hoskins , 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:  April Hoskins   Father:  Rob Hoskins         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 937-694-7707  MOM 937-321-8746

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Quinn Hoskins 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:  April Hoskins   Father:  Rob Hoskins         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  Jadney Kasule , 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:  Shannan   Father:  Ryan         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD   MOM

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Jadney Kasule 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:  Shannan   Father:  Ryan         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  Conrad Keim , 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 Keim   Father:  Jon Keim         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 937-321-8817  MOM 937-545-2853

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Conrad Keim 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 Keim   Father:  Jon Keim         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  Blake Mcvicar , 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:  Jennifer Mcvicar   Father:  Justin Mcvicar         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 937-902-0594  MOM 937-902-5830

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Blake Mcvicar 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:  Jennifer Mcvicar   Father:  Justin Mcvicar         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  Gavriel Nix , 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:  Jennifer Nix   Father:  Brian Nix         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 4789186836  MOM 4789186838

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Gavriel Nix 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:  Jennifer Nix   Father:  Brian Nix         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  Oscar Pica , 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:  Maryann Pica   Father:  James Pica         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 9374994319  MOM 9379999402

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Oscar Pica 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:  Maryann Pica   Father:  James Pica         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  Elyas  Shalash , 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:  Najwa Shalash   Father:  Mohammad Shalash         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 9376223962  MOM 9379030493

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Elyas  Shalash 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:  Najwa Shalash   Father:  Mohammad Shalash         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  Benjamin Stickel , 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:  Jessica Stickel   Father:  Jeff Stickel         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________

 

PHONE: DAD 9372414964  MOM 9373675355

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------  

 

Family Membership Agreement

I, the undersigned, being the parent and/or legal guardian of   Benjamin Stickel 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:  Jessica Stickel   Father:  Jeff Stickel         or  Guardian:    _______________

                                                                                                                                                                        

 

-->     Signature      ______________________________________________   Date   _______________