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TOURNAMENT INFORMATION
PLAYER INFO
All registration forms must be received by April 18th, 2015
HOOPS FOR HOMELESS
Saturday, April 25th, 2015
*Rain date April 26th, 2015
Hoops for the Homeless is a three-on-three
basketball tournament held outside in
downtown New Britain in Spring. This event
is organized by a board of local volunteers.
All proceeds from this event will be given to
local projects that will directly address
homelessness of children and families in our
city. Priority will be given to projects that
directly work to alleviate child homelessness.
How can you expect kids to
focus in school when they don’t
even know where they are
going to sleep that night?
And some kids have younger
siblings in the same situation.
-Tebucky Jones
Price Per Team is $50.*
Teams are four players, 3-on-3.
*No team will be turned down due to lack of funds, but we do
Date of Birth
Player 1’s Full Name (please print)
Email Address
Cell Phone #
encourage youth teams to be sponsored by local organizations
(schools, PALS, churches, YWCA, YMCA, etc.).
I have read and I understand the Waiver / Release of Liability on the back of this brochure
Signature of Player / Parent / Guardian
EXPECTED DIVISIONS:
(May be modified according to the participation)
Rookies — Grade 5 and 6, M / F, Co-Ed
Junior All-Stars — Grade 7 and 8, M / F, Co-Ed
All- Stars — Grade 9 -12, M / F, Co-Ed
Ballers — Age 19-29, M / F, Co-Ed
Hot Shots — Age 30 and above, M / F, Co-Ed
Legends — 50 and above, M / F, Co-Ed
Non-Competitive Open Division — TBA, M/F, Co-Ed
Disclaimer: The first 60 teams to sign up are guaranteed slots. Afterthat,
teams will be put on a waiting list. If not selected, teams canchoose to donate
their registration fees to our cause or register fornext year.
Please visit: http://www.ccsu.edu/HoopsForHomeless for more details.
MORE INFORMATION
ABOUT HOMELESSNESS
According to the McKinney-Vento Federal Homeless Act, which
ensures that children and youth experiencing homelessness have full
Player 2’s Full Name (please print)
Email Address
Date of Birth
Cell Phone #
I have read and I understand the Waiver / Release of Liability on the back of this brochure
Signature of Player / Parent / Guardian
Player 3’s Full Name (please print)
Email Address
Date of Birth
Cell Phone #
I have read and I understand the Waiver / Release of Liability on the back of this brochure
Signature of Player / Parent / Guardian
Date of Birth
Player 4’s Full Name (please print)
and equal access to an appropriate public education and that they
experience success in school, New Britain Schools have identified
roughly 350 homeless children.
Email Address
Cell Phone #
I have read and I understand the Waiver / Release of Liability on the back of this brochure
Signature of Player / Parent / Guardian
Homeless children, through no fault of their own, have to
NO CHILD
DESERVES TO BE
HOMELESS
contend with living in:
• Sub-standard, unsafe and/or unhealthy environments
• Doubled-up, overcrowded conditions
I have read and I understand the Waiver / Release of Liability on the back of this brochure
Coach / Team Contact Person Signature
• Emergency Shelters
• High mobility, from place to place and school to school due
to eviction
Print Name
Date
TEAM ROSTER
REGISTRATION
Please Read Before Signing
Hoops for Homeless Waiver / Release of Liability
In consideration of being allowed to participate in any way in the Hoops for Homeless Basketball
Tournament, related events and activities (collectively, the “event”), the undersigned, for him/herself,
his/her personal representatives, heirs, and the next of kin:
Please fill out BOTH SIDES of this form and a check written to
“Hoops for Homeless” for the appropriate amount ($50 per team,
but you are welcome to give more). Then, send both this form and
the check to the address at the bottom of this form.
KNOWLINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING
FROM THE NEGLIGENCE OF THE RELEASES or others, and assume all and full responsibility
for my participation; and,
Willingly agrees to comply with the stated and customary terms and conditions for participation. If
however he/she observes any unusual significant hazard during his/her presence or participation, he/
she will remove him/herself from participation and bring such to the attention of the nearest official
immediately; and
Hereby irrevocably grant to the Hoops for Homeless and its past and present affiliates, subsidiaries,
parent entities, licensees, successors and assigns, and those acting with its permission or upon its
authority (all of whom are referred to below as “licensed parties”) the absolute, perpetual, and
unrestricted right and permission to record, copy, reproduce, adapt, edit, summarize, photograph, film,
license, vent, distribute, televise, publish, exhibit, disseminate, perform and otherwise exploit in any and
all markets and media (collectively “use”) his/her appearance, name, likeness, voice, documents,
participation in the Event, other property, views, performance, efforts, recorded image and voice, as well
as all other documents and artifacts provided to Hoops for Homeless by him/her (collectively “the
materials”). This grant of rights is made without limitation upon time, circumstances, location, market or
medium of use and without any right to inspect or approve the materials or the uses to which any of the
materials may be put and without any payment due to him/her, and
TEAM INFO
Team Name
Acknowledges, appreciates, and agrees that the risk of injury from the activities involved in the Event is
significant, including the potential for injury, permanent paralysis and death; and
Age/Division
Team Contact Name
Team Contact Email
Phone #
Alternate Phone 3 or Email
Agrees that all audio and/or video recordings of the materials or any of them as well as all descriptions
or summaries of his/her personal history and/or view that are made and used by any licensed party will
be solely owned by Hoops for Homeless and that Hoops for Homeless may copyright its name and for
its sole benefit any such audio or video recording of the Event containing the materials or any of them;
and
Acknowledge, appreciates, and agrees that he/she had read this form and understand that by signing
this form, he/she is giving up legal rights and remedies on behalf of him/herself and his/her family,
estate, heirs, and/or assigns; and
HEREBY INDEMNIFIES, RELEASES AND HOLDS HARMLESS HOOPS FOR HOMELESS, Friendship
Service Center of New Britain, Inc., its affiliates, subsidiaries, and their officers, officials, agents and/or
employees, directors, other participants, sponsoring agencies, sponsors, advertisers, and if applicable,
owners and lessors of the premises used to conduct the event (“Releases”), WITH RESPECT TO ANY
AND ALL INJURY, DISABILITY, DEATH, or loss or damage or person or property, WHETHER ARISING
FROM THE NEGIGENCE OF THE RELEASEES OR OTHERWISE; and
HAS READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT HE/SHE HAVE GIVEN UP SUBSTANTIAL RIGHTS
BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT and
authorizes on his/her behalf any of the Releases to obtain any medical care or treatment deemed
necessary; and
Warrants and represents that he/she (1) is the owner of all rights granted hereunder or has been duly
authorized by the owner of such rights to grant same and (2) is at least eighteen (18) years of age or is
the legal parent or guardian of the minor child listed below and is executing this WAIVER / RELEASE
OF LIABILITY / REFUND POLICY / BAD WEATHER POLICY on behalf of such minor child. In the event
that the Undersigned is a legal parent or guardian of a minor child who turns the age of 18 during the
Event, the acknowledgment and agreement of such child is also required.
REFUND POLICY / BAD WEATHER POLICY
Make Check Payable to
“The Friendship Center/Hoops for Homless:
There will be no refunds granted for any reason before or after the registration deadline. This included,
but is not limited to inclement weather, etc. In case of inclement weather, the Event Director reserves
the right to reduce the number of scheduled games and/or the time of games and/or postpone or delay
game times and/or cancel the Event. Every effort will be made to complete games and the tournament.
3rd Annual 3-0n-3
Basketball Fundraiser to
End Homelessness of Children
and Families in New Britain
Saturday, April 25th, 2015
Main St / W. Main St
New Britain, CT, 06053
Donation and
Team Registration
Information
Hoops for Homeless
Hoops for Homeless
Scott Kazar
Student Center Office
Central Connecticut State University
1615 Stanley Street
New Britain, CT 06053
Phone: 860-832-1962
Email: st_sk6247@mail.ccsu.edu
Scott Kazar
Student Center Office
Central Connecticut State University
1615 Stanley Street
New Britain, CT 06053
Phone: 860-832-1962
Email: st_sk6247@mail.ccsu.edu
http://www.ccsu.edu/HoopsForHomeless