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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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 _______________