FCA Knight's Basketball Registration 2018
Please complete the online form below and read all information.

Basketball Registration due MONDAY, OCTOBER 29TH!

There will be no parent meetings. All communications will happen through email and our team app. All documents will be emailed and must be signed/completed and returned by the end of the 1st week of practice.

Parents/Guardians will be required to sign off on a copy of this form and its corresponding agreements and have returned by the end of the first week of practice. We will email you the document at the start of the season. There will be more information as we get closer. This Registration/Agreement must be signed in order for your child to practice or compete past the first week of practice. We will collect fees and physicals at this time also.

Please make sure that you have answered all questions. When form is complete and submitted you should receive a pop-up window that will say "Thank you for your Registration"

If there are any questions please call or email the Athletic Director, Jimmy Standlea at knightsad@fcaclassical.com or call at 816-739-2481. Thank you and we look forward to a great season!

Year *
Sport *
Student Athlete's First Name *
Your answer
Student Athlete's Last Name *
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Mother's Cell Phone *
Your answer
Father's Cell Phone *
Your answer
Mother's Email Address *
Your answer
Father's Email Address *
Your answer
Student/Athlete's Email Address *
Your answer
Student/Athlete's Birthdate *
Your answer
Student/Athlete's Cell Phone *
Your answer
Student/Athlete's Grade *
Student/Athlete's Age *
Insurance
We hereby give our consent for the above student to participate in athletics with Faith Christian Academy Sports. If we cannot be reached we authorize an adult sponsor or coach (any adult in whose care my student has been entrusted) to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis, or treatment and hospital care, to be rendered to the student under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical
Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned student pursuant to this authorization. Should it be necessary for my student to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. I am agreement and show my agreement by entering my initials below and date that I submitted this form.
Insurance (agreement to above). *
Your answer
Said Student/Athlete is covered by Insurance *
Insurance Company *
Your answer
Policy Number *
Your answer
Insurance Phone Number *
Your answer
Insurance City *
Your answer
Insurance State *
Your answer
Insurance Zip *
Your answer
Emergency Contact Name (Other than Parent) *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Home Phone *
Your answer
Emergency Contact Cell Phone *
Your answer
Emergency Contact Work Phone *
Your answer
Primary Physician Name *
Your answer
Primary Physician Number *
Your answer
Are you now, or have you ever been, treated for any of the following? *
Check next to any that apply
Required
List any allergies or reactions to medicines: *
Put "NONE" if None
Your answer
List any operations, serious injuries, or hospitalizations for any reason: *
Include dates/ Put "NONE" if None
Your answer
List current medications and dosages below: *
Include medicine name, amount and frequency of dosage, and reason. Please put "NONE" if None
Your answer
Give date of last innoculation or date of disease for DIPTHERIA, PERTUSSIS, TETANUS (Tdap) *
If not immunized, put "NONE"
Your answer
Give date of last innoculation or date of disease for MEASLES, MUMPS, RUBELLA (MMR) *
If not immunized, put "NONE"
Your answer
Give date of last innoculation or date of disease for HEPATITIS B: *
If not immunized, put "NONE"
Your answer
Photography Consent
FCA includes photographs in various publications including, but not limited to, web site pages, informational fliers, and programs. By checking "permit" below, parent of minors understand that they are granting permission for the use of their child/athlete's image or likeness to be included in any and all forms of media in relation to school publications for Faith Christian Academy. Sports photographs are not used for purposes other than school related media.
Photography Consent *
Transportation
We understand that FCA does not provide transportation to all events and permit /do not permit (choose one below) my child to drive his/her vehicle in such a case. We assume all responsibility for this decision.
Transportation Response *
Waivers and Disclaimers
The undersigned parent or guardian consents to my child participating in sports with Faith Christian Academy . During season, the student will be asked to take part in physical activities such as running, jumping, drills, and other physical conditioning activities. I certify that my child is able to participate in a sports program. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them below. In the event an emergency occurs, I may be reached at the telephone number listed above. If I cannot be reached, I hereby authorize an adult sponsor or coach to make emergency medical decisions for my child. If there are any activities I do not want my child to be involved in, I have listed them below.

I understand and hereby agree to assume all of the risks which may be encountered by
participating in sports activities, including activities preliminary and subsequent thereto. I do
hereby agree to hold FCA and its agents (including the facilities where FCA holds its
practices and games) harmless from any and all liability, actions, causes of actions, claims,
expenses, and damages on account of injury to my child or property, even injury resulting in
death, which I now have or which may arise in the future in connection with the activity or
participation in any other associated activities.

We also hereby grant permission for our student named above to participate in student travel to
and from games and practices. We grant permission for our student to participate in the planned activities of travel and to travel by car, bus, or other means of transportation as required. All persons representing FCA are released and forever acquitted from all and any claims of liability by us or our child or both for injuries sustained by our child because of such participation.

We further hereby agree to hold harmless and to indemnity FCA of and from any and all
actions, causes of action, claims, liabilities, costs and expenses, including attorney fees, on
account of or in any way growing out of injuries sustained by our child because of such
participation.

The undersigned do also hereby give permission for our student to ride in any vehicle
designated by the adult in whose care the student has been entrusted while participating in athletics with Faith Christian Academy Sports. I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the State of Missouri and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand and acknowledge by entering my initials below.

Authorization Initials of Parents *
Enter your initials
Your answer
Date Form Filled Out *
Your answer
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