U19 Girls Tournament Team Registration Form (Online) Briers Basketball Club 411 Elgin Street Brantford, ON N3S-7P5 Tel: 519-756-8435 Email: email@example.com www.briersbasketball.ca U19 Girls Tournament Team Registration (December 9-11, 2016) Tournament Date: December 9-11, 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) 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: Team Contact Name: Address: City: Postal Code: Email: Phone Number: Tournament Deposit And Entry Fee: I agree that tournament entry fee of $650, must be paid in full prior to registration deadline of November 14, 2016 in order to participate. Please Select: $50.00 Non-refundable Deposit via cheque (To Reserve) $52.00 Non-refundable Deposit via PayPal (To Reserve) $650 Entry Fee via cheque 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 Team Named Above (hereinafter referred to as “the team”), 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 team 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 the team 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"