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 Cooper Arden , 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: Caitlin Arden Father: Joshua Arden or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9375167619 MOM 9373046556
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Cooper Arden 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: Caitlin Arden Father: Joshua Arden 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 Winston Baldree , 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: Cheri Baldree Father: Michael Baldree or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 567-307-9387 MOM 316-928-0221
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Winston Baldree 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: Cheri Baldree Father: Michael Baldree 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 Kayden Drake , 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: Edie Drake Father: Tim Drake 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 Kayden Drake 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: Edie Drake Father: Tim Drake 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 Cory Harbarger , 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: Dustin Broughton or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 9374745183 MOM 937-409-1542
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Cory Harbarger 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: Dustin Broughton 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 Lincoln Hauge , 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: Collette Father: Jonathan or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 6142080062 MOM 4193436158
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Lincoln Hauge 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: Collette Father: Jonathan 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 George Merrill , 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: Molly Merrill Father: Brian Merrill or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-609-8687 MOM 937-474-2609
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of George Merrill 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: Molly Merrill Father: Brian Merrill 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 Sullivan Mohler , 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: Randi Mohler Father: Clint Mohler 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 Sullivan Mohler 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: Randi Mohler Father: Clint Mohler 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 Charlie Ryberg , 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: Abby Ryberg Father: Randy Ryberg or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-903-0668 MOM 937-475-0374
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Charlie Ryberg 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: Abby Ryberg Father: Randy Ryberg 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 Henry Ryberg , 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: Abby Ryberg Father: Randy Ryberg or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-903-0668 MOM 937-475-0374
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Henry Ryberg 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: Abby Ryberg Father: Randy Ryberg 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 Brandt Thobe , 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: Krista Thobe Father: Mark Thobe or Guardian: _______________
--> Signature ______________________________________________ Date _______________
PHONE: DAD 937-620-0724 MOM 8037275797
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Family Membership Agreement
I, the undersigned, being the parent and/or legal guardian of Brandt Thobe 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: Krista Thobe Father: Mark Thobe or Guardian: _______________
--> Signature ______________________________________________ Date _______________