Name Of Player:
Address:
Phone:
E-Mail:
Date of Birth:
School:
School Coach:
Current Grade:
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Player Experience:
Terms and Agreement
By hitting "Send" I acknowledge my son/daughter is physically fit to participate in strenuous athletic activity and I waive Rome
Select Basketball of any and all responsibility resulting in Injury or Illness. I hereby authorize
the directors / coaches of Rome Select basketball to act for me according to their best
judgment in any emergency requiring medical attention. I understand that I am solely
responsible for the payment of any such medical expenses and must provide this organization
with proof of medical and accident insurance before playing in any tournaments.
Are You Interested In Helping Out Being A:
Team Parent, Assistant Coach, or Head Coach? If So Which?
There are many activities for children and their families throughout the year with Rome
Select Basketball. In many cases, there will be photography at these events. Rome Select
Basketball will publish the photos from time to time for use on our website, as well as in
addition to various print materials. We ask that parents of minor children to give permission
for Rome Select to use their children's photos.
Initial.
Name Of Parent/Guardian:
Parent/Guardian Phone:
Parent/Guardian Email:
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