Hamden Connecticut Youth Basketball

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HAMDEN FATHERS' BASKETBALL ASSOCIATION                                          Check Box:    ___ Boy ___ Girl 

AND                                                                                                                       Players’ Age as of December 31st, 2017                     HAMDEN DEPARTMENT OF RECREATION                                    

                              2017-2018 SEASON                                PLEASE PRINT PLAYERS INFORMATION                                                                                                                                        

NAME:                                                                                                                                                                                                                                       

               LAST                                                                                                                   FIRST

 

ADDRESS:                                                                                                                                                                                                                                 

 

PHONE CONTACT #’S:                                                                                                                                                                                                          

 

DOB:                                                                         SCHOOL ATTENDING;                                                                                                                      

                 MONTH/ DATE / YEAR

 

CONTACT E-MAIL ADDRESS:                                                                                                                                                                                            

 

LAST YEARS TEAM NAME:                                                                                                                                                                                                

 

DOES PLAYER HAVE ANY PHYSICAL DISABILITIES?                                                                                                                                              

As parent or guardian for the above referenced child, I give my permission for my child to participate in the Hamden Father’s Basketball Association and acknowledge the risks involved with participation, including and not limited to injury.  I, on behalf of my child, waive all claims relating to my child’s participation against the organization, and assume all risks associated with participation, including transportation to and from activities. 

As parent or guardian for the above referenced child, I acknowledge receipt of the Code of Conduct and agree that these policies govern the conduct of myself and my child relating to all Hamden Father’s Basketball Association.  The failure of myself or my child to comply with the Code of Conduct could result in sanction by the Association, including removal of myself or my child from the league.  I accept that compliance with the Code of Conduct is a condition of participation and agree to comply with these rules. 

Hamden Father’s Basketball Association does provide excess insurance coverage for medical expenses required due to injury to your child.  In order to obtain coverage under this policy, you must first exhaust all other benefits provided by any applicable insurance policies that provide coverage for your child prior to submitting a claim on behalf of your child.

My signature, whether by electronic means or otherwise, serves as an acceptance of these terms and conditions of participation as outlined in this document. 

 

                                                                                        YES   NO                                                                                                                                       

Has Birth Certificate been checked:                           ____  ____               PARENT/GUARDIAN SIGNATURE:                      

Has Registration Fee been paid:                                 ____ ____                                                                                                                                                                   

Does Parent/Guardian wish to assist in activities?   ____ ____                PARENT/GUARDIAN PRINTED NAME:

                                                                                                                        HFBA REPRESENTAIVE:                                                                                   

Please mail to: HFBA C/O Richard Shultz 6 Roosevelt Street Hamden, CT 06514 to be received by October 9th, 2017

There is a $10.00 Late Fee if not received by October 9th, 2017

Please print E-Mail address clearly and if you have multiples please list.

Please go to: www.rainedout.com and register for weather notifications and cancellations to receive on your cell phone and /or

e-mail address follow instructions from site