Briers Program Registration Form (Online)

Program Registration With Briers Basketball Club; PO Box 21045, RPO Lynden Park Mall, Brantford, ON N3R 7W9

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Participant's First Name:

Participant's Last Name:

Address:

City:

Postal Code:

Email (1):

Email (2): Optional

Phone Number:

Birthdate: (MM/DD/YYYY)

Gender:

Female
Male

Basketball Skill Level

1-Beginner
2
3-Intermediate
4
5-Advanced

Briers Reversible (Blue/White) Jersey Purchase @ $30.00 each: Optional

No Purchase
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Large
Adult XLarge

Enrollment is limited and on a first-come/first paid basis. Payment of registration fee is required to hold the spot.

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Acknowledge Method Of Payment

Credit Card (Upon receipt and review of the program registration form, Briers will provide an email invoice which will allow for online payment.)

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.

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LIABILITY WAIVER: To: THE BRIERS BASKETBALL CLUB, its agents, employees, contractors, administrators, sponsors, coaches, convenors, managers or assigns: I, the undersigned, the parent or legal guardian of Participant 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. I, the undersigned, acknowledge that the above-noted LIABILITY WAIVER, is applicable to me when I am participating in the activities of the Briers Basketball Club. By signing below, I assume all risks associated with the game of basketball.

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PHOTO USE: I hereby agree that the above participant’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.

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NAME USE: I consent to the use of the participant’s name for the purposes of publishing participant names, game results and statistics.

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You acknowledge receiving email updates from our organization through your program registration with Briers Basketball Club.

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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)

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If, in the sole discretion of our coaches/convenors, you, and/or the participant, disrespect the Ontario Basketball Association ‘Fair Play Policy’, you, and/or the participant, will be asked to leave the facility. Penalties for misconduct may be imposed.

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I, the undersigned, certify that I have read and agree to all the terms and conditions as noted above, and do intent to be legally bound thereby.

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Date: (MM/DD/YYYY)

Signature - enter name: (Parent/Legal Guardian Signature if Participant is under 18 years of age)

We are seeking experienced instructors to coach our basketball programs. Note your program of interest.