3 on 3 Tournament Team Registration Form (Online) Briers Basketball Club411 Elgin StreetBrantford, ON N3S-7P5Tel: 519-756-8435 Email: email@example.com www.briersbasketball.ca 3 on 3 Tournament Registration (August 13, 2016) Tournament Date: August 13, 2016 Note: As we are limited to the number of teams that can participate, prior to submitting your registration form and tournament deposit or entry fee payment, you must email Briers Basketball (firstname.lastname@example.org) requesting availability for your team's age division, and to receive your team number. Submitting your registration deposit, and/or, payment without a team number, will result in a $50 administrative fee retained on all refunds. Team Number: Team Name: (no more than 20 characters and consist of letters only) Team Gender Female Male Team Contact Name: Address: City: Postal Code: Email: Phone Number: Player One Name (Team Captain): Birthdate: (d/m/year) Shirt Size: Please Select Youth Small Youth Medium Youth Large Youth XLarge Adult Small Adult Medium Adult Large Adult XLarge Player Two Name: Birthdate: (d/m/year) Shirt Size: Please Select Youth Small Youth Medium Youth Large Youth XLarge Adult Small Adult Medium Adult Large Adult XLarge Player Three Name: Birthdate: (d/m/year) Shirt Size: Please Select Youth Small Youth Medium Youth Large Youth XLarge Adult Small Adult Medium Adult Large Adult XLarge Player Four Name: Birthdate: (d/m/year) Shirt Size: Please Select Youth Small Youth Medium Youth Large Youth XLarge Adult Small Adult Medium Adult Large Adult XLarge Tournament Deposit And Entry Fee By PayPal Only: (Link on Briers website) I agree that tournament entry fee of $XXX, must be paid in full, via the PayPal link on Briers website, prior to registration deadline of XXXXX in order to participate. Please Select: Fee By PayPal Only: (Link on Briers website) $50.00 Non-refundable Deposit (To Reserve) $XXX Entry Fee Note: Teams withdrawing from the tournament prior to the registration deadline, will be refunded the registration fee, less a $50 administrative fee. Refunds will not be given to teams that; (1) withdraw after the registration deadline, (2) have participated in the tournament for any reason including disciplinary reasons. LIABILITY WAIVER: To: THE BRIERS BASKETBALL CLUB, its agents, employees, administrators, sponsors, coaches, convenors, managers or assigns: I, the undersigned hereby authorize and permit the Players Named Above (hereinafter referred to as “the players”), 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 players 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. PHOTO USE: I hereby agree that the above team/players name/photograph/image/audio recording/video recording, or other visual reproduction may be used by Brantford Briers Basketball, The RISE Centre, and Aerial Promotions, in its promotional, publicity and informational material. NAME USE: I consent to the use of the team/players name for the purposes of publishing participant names, game results and statistics. You acknowledge receiving email updates from our organization through your program registration with Briers Basketball Club. IF, IN THE SOLE DESCRETION OF OUR CONVENORS/COACHES, YOU DISRESPECT THE SPIRIT OF FAIR PLAY YOU WILL BE ASKED TO LEAVE THE FACILITY. On behalf of all players noted above, 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) Authorized Team Representative Signature: (Enter Authorized Team Representative Name) Submit "LET'S MAKE BASKETBALL HAPPEN"