Friendly House Youth Hoops Basketball 24-25

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Hello Families!

We are super excited to have you and your child join our basketball program! You will be getting an email from us right after you have registered your child with further information and the next steps, so please be on the look out for that. If you have any questions, email us at fhyouthdept@gmail.com

Child's First Name *

Child's Last Name *

Age *

Date Of Birth

YYYY

Gender *

Grade *

School Attending *

Address (Please put Apartment Number, City, State and Zip Code) *

Race *

White

Black/African American

Asian

American Indian/Alaskan Native

Native Hawaiian/Other Pacific Islander

American Indian/Alaskan Native and White

Asian and White

Black/African American and White

American Indian/Alaskan Native and Black/African American

Other:

Ethnicity *

Hispanic/Latino

Not Hispanic/Latino

Required

Does your child have any allergies, illnesses or conditions?
*

Is your child taking any medication?
*

Does your child have any specialized behavior support? IEP, 504, etc.
*

Yes

Required

Parent/Guardian First and Last Name
*

Phone Number
*

Relationship To Child
*

Address (Please put Apartment Number, City, State and Zip Code)
*

Email
*

Emergency Contact #1 First and Last Name
*

Emergency Contact #1 Phone Number
*

Relationship With Child
*

Emergency Contact #2 First and Last Name
*

Emergency Contact #2 Phone Number
*

Relationship With Child
*

Media Permissions
*

I acknowledge by checking the boxes below, I give Friendly House permission to use photo (print and digital), video, audio or other representation of my child without name for:

1-Onsie display including slideshows, videos and artwork.

2-Use via print or Friendly House email in newsletters, distribution to families and/or staff, marketing and business materials.

3-Use on the internet including Friendly House website, social media and/or other media resources.

Yes, I give Friendly House permission to use my child's photo without name.

No, I do not give Friendly House permission to use my child's photo without name

Off-Site Permissions
*

By clicking below, I state that I understand that Friendly House basketball includes some activities offsite (defined as anywhere away from 36 Wall Street) and give permission for my child to travel with Friendly House Inc. and participate in these activities. Further, I for myself and on behalf of my heirs, assigns and next of kin, understand that these trips are a service of the Friendly House, Inc. and as partial consideration (in exchange) therefor HEREBY RELEASE AND HOLD HARMLESS FRIENDLY HOUSE, INC., their officers, officials, agents and/or employees, other participants , sponsoring agencies , affiliates, contractors, and sponsors ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property resulting in any way from the conduct and/or negligent conduct of the Releases in the course of any activity offsite (including ravel to and from); and further agree that in the event that a claim is brought by participant or Releases against the other resulting from a trip, the defendant shall be able to recover reasonable attorney's fees if incurred in successfully defending against such claim.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTATIONAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY.

*FOR PARTICIAPANTS OF MNORITY AGE ( Under 18)*

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and for myself , my heirs, assigns, and next of kin. I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor's child's involvement or participation in activities as provided above.

I give permission for my child's to participate in all of the off-site scheduled activities.

Deposit and Payment Agreement
*

I understand that all monies paid are non-refundable and non-transferable. I also understand that if the $75 payment is not received by September 20, 2024 for the first month, that I may lose my child's place within the basketball program. Please call us at 267-257-9519 to make the payment with a credit & debit card. WE DO NOT ACCEPT CASH & CHECKS!

By clicking you acknowledge you read the Deposit and Payment Agreement

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