BasketballTournament
Hastings Public Pool Fundraising Team Hastings Public Pool Hastings Hastings Fundraising Public Public Team Pool Fundraising Pool Team Fun Perk Up the Pool “ Perk Up the Pool ” PerkPerk Up the Pool Up the Poo 33on Tournament on 33 Basketball Basketball Tournament 3 3 on on 3 Basketball 3 Basketball TournamentTour $30.00/team July 18th & 19th, 19th, 2015 2015 Registration Form $30.00/team$30.00/team July $30.00/team 18th & JulyJuly 18th Registration & 18th 19th, 2015 & Form 19th, Regist 3 on 3 Basketball Tournament – Registration Form & Waiver 3 on 3 Basketball Tournament –3 Registration on33 Basketball Basketball Form Tournament & Waiver – Registration Form & Waiver 3 on Tournament – Registrat Team Name:__________________________________________________________ Team Name:__________________________________________________________ Team Name:_______________________________________________________ Team Name:___________________________________ Team Captain’s Name:__________________________________________________ Team Captain’s Name:__________________________________________________ Team Captain’s Name:_______________________________________________ Team Captain’s Name:___________________________ Captain’s Captain’sAddress:______________________________________________________ Address:______________________________________________________ Address:__________________________________________________ Captain’sCaptain’s Address:______________________________ Captain’s Captain’sPhone:_______________________________________________________ Phone:_______________________________________________________ Phone:___________________________________________________ Captain’sCaptain’s Phone:________________________________ E-mail forforTeam or E-mail TeamCaptain Captain orContact:________________________________________ Contact:________________________________________ E-mail for Team Captain or or Contact:____________________________________ E-mail for Team Captain Contact:________________ Name PhoneNumber Name Number & Phone Name Grade &Number PhoneDate Number of Birth GradeGrade Date of T-Shirt Birth Date Size Male/Female of BirthT-Shi Name && Phone Grade Birth Male/Female Male/Female T-Shirt Size 2014yr. yr. 2014 2014 yr. YL,YL, SM, M,M, LG,LG, XL,XL, XXLXXL 2014 yr. YM, YM, SM, YM, Y AgeDivisions: Divisions:99&&under, under, Age 10-11, 10-11, Divisions: Age12-13, 12-13, Divisions: 14-15, 99 & & 16-18, under, under, 10-11, 19 & older, 10-11, 12-13,3014-15, & older 12-13, 16-18, 19 14-15, & older, 30 16 &o Age 14-15, Age Divisions: 11-15 years and16-18, 16 & up19 & older, 30 & older ALL PLAYERS ANDALL A PARENT/GUARDIAN PLAYERS ALL PLAYERS AND FOR AND EACH AA PARENT/GUARDIAN PARENT/GUARDIAN PLAYER MUST SIGN FOR THIS EACH WAIVER PLAYER FOR MUST EACH SIGN THIS PLA W ALL PLAYERSAND ANDAAPARENT/GUARDIAN PARENT/GUARDIANFOR FOR EACH EACH PLAYER WAIVER ALL PLAYERS PLAYERMUST MUSTSIGN SIGNTHIS THIS WAIVER understand by signing signing this I acknowledge and assume the risks I understand that Ibyunderstand signing thisI document, that Ithat acknowledge by anddocument, this assumedocument, the risks I acknowled I Iunderstand that by by signing thisthis document, I acknowledge and assume the risks understand that signing document, I acknowledge and assume theinherent risks in the theon 3 onherby 3 basketball herby The City of Ithac inherent in the 3 on inherent 3 basketballinherent in tournament thein 3 and 3 basketball relievetournament The Citytournament of and Ithaca, therelieveand herby 3 on 3 inherent basketballintournament hereby relieve: The Hastings Borough, Fundraising Team/Members, the 3 on 3 and basketball tournament and herby relievethe The City of Ithaca, the ICAA, and ICAA, Ithaca and and Ithaca Funfest Sponsors of any andof all any liability.and all liability ICAA, and Ithaca Funfest Sponsors of any allFunfest liability.Sponsors and Ithaca the Hastings Pool Sponsorsofofany anyand andall allliability. liability. 4 Players (sub) welcome. ICAA, and Funfest Sponsors Player’s Signature:_______________________________ Player’s Signature:________________________________________Date:______ Player’s Signature:________________________________________Date:__________ Player’s Signature:________________________________________Date:__________ Parent/Guardian Parent/Guardian Signature:_______________________ Signature:_________________________________Date:______ Parent/Guardian Signature:_________________________________Date:__________ Parent/Guardian Signature:_________________________________Date:__________ Player’s Signature:_______________________________ Player’s Signature:________________________________________Date:______ Player’s Signature:________________________________________Date:__________ Player’s Signature:________________________________________Date:__________ Parent/Guardian Parent/Guardian Signature:_______________________ Signature:_________________________________Date:______ Parent/Guardian Signature:_________________________________Date:__________ Parent/Guardian Signature:_________________________________Date:__________ Player’s Signature:_______________________________ Player’s Signature:________________________________________Date:______ Player’s Signature:________________________________________Date:__________ Parent/Guardian Parent/Guardian Signature:_______________________ Signature:_________________________________Date:______ Parent/Guardian Signature:_________________________________Date:__________ Player’s Signature:________________________________________Date:__________ Parent/Guardian Signature:_________________________________Date:__________ Player’s Signature:_______________________________ Player’s Signature:________________________________________Date:______ Player’s Signature:________________________________________Date:__________ Parent/Guardian Parent/Guardian Signature:_______________________ Signature:_________________________________Date:______ Parent/Guardian Signature:_________________________________Date:__________ Player’s Signature:________________________________________Date:__________ Parent/Guardian Signature:_________________________________Date:__________ Completed registration Completed form Completed and waiver registration registration with your form check and form need waiver to and with be your waiver check need wit t Completed registration form and waiver with your check need to be dropped off dropped off to Alley-T by August,your 17 to 2013 dropped off Alley-T byAlley-T August, dropped off to by Augu Completed registration form andOffice waiver check need to be 17 2013 at Hastings Borough bywith July 16, 2015. Checks Checks payable to : “Perk Up to the: Park” “Perk Up Checksoff payable to : “Perk Up thepayable Park” dropped to Alley-T by August, 17 2013 Checks payable to : “Perk Up the Pool” t en m a rn Registrations can also Registrations be mailed Registrations to can can also also be be mailed mailed Questions to to or Concerns: Questions or Concer u To Checks payable to : “Perk Up the Park” e T e th a t m a e C b l a il p w ta s ins Registration can alsoicaaperkupthepark@yahoo.com be mailed to: Alley-T Alley-T location Alley-T Are Ricaaperkupthepark@yah Registrations Questions or Concerns: e rial Gym can also be mailed to p o103 so n si Mem ble S. Jeffery Ave.103 S. Jeffery 103 S. Jeffery Ave. Ave.Borough Office Hastings F astings Park o icaaperkupthepark@yahoo.com r & HAlley-T A ll (3 ) 5 minuMI Ithaca, MI 48847 Ithaca, 48847 MI 48847 teIthaca, 207 5th Avenue Team Member 103 S. Jeffery Ave. p er io d s ATTN: Jenna-ICAAATTN: Jenna-ICAA ATTN: Jenna-ICAA Wearing Sames Hastings, PA 16646 Ithaca, MI 48847 Color Shirt le ATTN: Sam Patterson ATTN: DoubJenna-ICAA ion inat Elim Questions or Concerns: smp353@yahoo.com
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