2020 – 2021 Briers Program Registration Form (Online) 519-756-8435 firstname.lastname@example.org www.briersbasketball.ca Program Registration With Briers Basketball Club; PO Box 21045, RPO Lynden Park Mall, Brantford, ON N3R 7W9 Agree Select Basketball Program: Online/Virtual Training-Private (1on1) Sessions, Monday, Interactive with Coach Kojo (Ages 4+) $80.00 Online/Virtual Training-Private (1on1) Sessions, Wednesday, Interactive with Coach Kojo (Ages 4+) $80.00 Online/Virtual Training-Private (1on1) Sessions, Saturday, Interactive with Coach Kojo (Ages 4+) $80.00 Online/Virtual Training-Private (1on1) Sessions, Tuesday, Interactive with Coach Matt (Ages 11+) $80.00 Online/Virtual Training-Private (1on1) Sessions, Wednesday, Interactive with Coach Matt (Ages 11+) $80.00 Online/Virtual Training-Sessions with Coach Happy (Ages 8-9-10) $50.00 Online/Virtual Training-Sessions with Coach Happy (Ages 11-12-13) $50.00 Participant's First Name: Participant's Last Name: Address: City: Postal Code: Email: Phone Number: Birthdate: (m/d/year) Gender: Female Male Briers Reversible (Blue/White) Jersey Purchase @ $25.00 each: Optional 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. Upon receipt of full payment of the program registration fee, the above registrant will be 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, 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. Agree 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. Agree NAME USE: I consent to the use of the participant’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/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. Agree 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. Agree Date: (d/m/year) Signature - enter name: (Parent/Legal Guardian Signature if Participant is under 18 years of age) "LET'S MAKE BASKETBALL HAPPEN"