2020 – 2021 Briers Program Registration Form (Online) Briers Basketball Club PO Box 21045 RPO Lynden Park Mall Brantford, ON N3R 7W9 Tel: 519-756-8435 Email: email@example.com www.briersbasketball.ca Select Basketball Program: 2020 Spring Intro To Basketball - U9 Co-ed Ages 6,7,8 (2011/2012/2013) $90.00 2020 Spring 3 on 3 - U14 Co-ed Ages 11,12,13 (2006/2007/2008) $90.00 Private Lessons Player's First Name: Player's Last Name: Address: City: Postal Code: Email: Phone Number: Emergency Contact Name and Phone Number: Birthdate: (m/d/year) Gender: Female Male Briers Reversible (Blue/White) Jersey Purchase @ $25.00 each: Recommended No Purchase Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge Enrollment is limited and on a first-come/first paid basis. Payment of program registration fee is required before the above registrant is allocated to the above-selected program. Agree Please Select Method Of Payment Interac e-Transfer Credit Card Note: [$30 charge on all NSF] Refunds for non-rep programs, will be issued after a written request (email accepted) is received subject to the following: 1. Full refund less $20.00 administration fee if the refund request is received prior to the first scheduled program session. 2. If the refund request is received on or after the start date of the first scheduled program session, a prorated number of sessions refund from the date of the written request is received, less $20.00 administration fee and less OBA player insurance fee. Rep Program - There are no refunds due to the difficulty of replacing players and upfront fees paid for season play, insurance, and gyms. Agree Become a Volunteer (note your area of interest): LIABILITY WAIVER: To: THE BRIERS BASKETBALL CLUB, its agents, employees, administrators, sponsors, coaches, convenors, managers or assigns: I, the undersigned, the parent or legal guardian of Player Named Above (hereinafter referred to as “the player”), hereby authorize and permit the player to participate in the activities of the Briers Basketball Club. In giving this authorization and, in the event of any injury or loss occurring to the player at any time during the current season, I hereby release and agree to bring no action whatsoever or assert any cause of action whatsoever against the Briers Basketball Club, or any of its agents, employees, administrators, sponsors, coaches, convenors, managers or assigns by reason of any alleged act of negligence, breach of contract or statutory duty or any other cause of action known to law. By signing below, I assume all risks associated with the game of basketball. Agree PHOTO USE: I hereby agree that the above player’s name/photograph/image/audio recording/video recording, or other visual reproduction may be used by Brantford Briers Basketball, its agents, employees, administrators, sponsors, coaches, convenors, managers or assigns, in its promotional, publicity and informational material. Agree NAME USE: I consent to the use of the player’s name for the purposes of publishing participant names, game results and statistics. Agree You acknowledge receiving email updates from our organization through your program registration with Briers Basketball Club. Agree You acknowledge participants are to provide their own basketball. Recommended ball size; • Ages 11 and younger - #5 (27.5) • Ages 12 & 13 - #6 (28.5) • Boys 14+ - #7 (29.5) • Girls 14+ - #6 (28.5) Agree If, in the sole discretion of our coaches, you disrespect the spirit of fair play you will be asked to leave the facility. Agree I certify that I have read all the terms and conditions as noted above, and do intent to be legally bound thereby. Agree Date: (d/m/year) Parent/Guardian Signature (Enter Parent/Guardian Name) "LET'S MAKE BASKETBALL HAPPEN"