Tryout # _________

(assigned at tryout time)

 

Thank you for trying out for the Future Firebirds Select Cheer.

Important: If a parent or legal guardian will not be coming in to the tryouts with the player, you must print and sign this form and send with the player to the first tryout.  After printing, click here to return to the Kettering Basketball Club Home page.

Player Name:

 Charlette Pedro Mother:  jessica ciesa

Sex:

  Father:  Marc Pedro

Birth Date:

 02/21/11 (or) Guardian:  

Street Address:

 2721 Aerial Ave  

City:

 Kettering

State:

 Ohio

Zip Code:

 45419

School:

 Orchard Park Home Phone:  

Grade:

 3rd Work Phone:  
Cell Phone:  9377231451
E-Mail Address:  jessicaciesa@yahoo.com

 

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In consideration of the above named player having the opportunity to participate in tryouts for the Kettering Basketball Club, I agree to hold harmless the Kettering Basketball Club, its administrators and coaches; the Kettering Board of Education and their employees; and the volunteers assisting at these tryouts of any liability what-so-ever with regards to any injury that might occur to me or the above name player as a result of them participating in this tryout activity.  By signing below, I represent to the Kettering Basketball Club that the above player is medically fit to participate in cheer and I accept full responsibility for his/her medical condition.  I assume all risks and hazards incidental to the nature of this activity.   

 

 

_________________________________                       _______________________

Signature of Parent or Legal Guardian                          Date