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Motion Basketball: General Form
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Parent / Guardian Information
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Step
1
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Name
*
First
Last
Name
First
Last
Home Phone
Home Phone
Mobile Phone
*
Mobile Phone
Email
*
Email
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Next
Athlete Name
*
First
Last
What Program do you want to register them in
*
Rep Player
Be a Pro School and Basketball League
March Break Camp
Summer Camp
Training/Development
Tutoring
Other
Please Write the Program:
*
Tshirt Size
*
Small
Medium
Large
Extra Large
Other
If other was selected, please write size here.
Athlete Date of Birth
*
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Gender
*
Male
Female
Other
Athlete Phone Number
Athlete Email
Health Information
Allergies
Asthma / Respiratory issues
Blackouts/Fainting
Chest Pain
Diabetes
Epilepsy
Heart Disorder
Heart Condition
Seizures
Recurring Headaches
Glasses
Contact Lenses
Injuries
Medication
Other
Other:
*
If other or medications was selected please describe in more detail.
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Checkboxes
*
I/We agree to abide by all rules and regulations of the Motion Ball Sports Association
*
Motion Ball Sports Association (MBSA) will not be held responsible for any injuries sustained by a player while playing at any facility or programs operated by the MBSA.
I/We acknowledge that all intellectual property, rights and ownership of any media taken and any reproduction thereof, arising from any sports of interests, and/or activities will belong to the MBSA. I/We hereby release, discharge and agree to save harmless any MBSA parties from all liability arising in connection with the sport(s) of interest, and/or activity.
There is a cancellation fee of $75.00. No refund will be issued after the 2nd week of the program. A fee of $45.00 will be charged for all NSF Cheques.
This form must be signed by a parent/guardian if the player is under eighteen years of age.
Submit