Team Peak Information & Consent Form
This form is required for 2020-21 season with Team Peak.
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Player's First Name
Player's Last Name
Grade Level
Birthdate (we will need copy of report card or birth certificate for some tournaments!)
MM
/
DD
/
YYYY
Returner Jersey #/ New-Preferred Jersey #'s (2 choices please)
Parent/Guardian Name (#1)
Parent/Guardian Email (#1)
Parent/Guardian Phone (#1)
Parent/Guardian Name (#2)
Parent/Guardian Email (#2)
Parent/Guardian Cell (#2)
Medical Insurance Carrier & Plan Number
Physician Name & Phone Number
Known Allergies & Current Medications
Other Pertinent Medical Information
Emergency Contact Name & Relationship
Emergency Contact Number
 I hereby authorize Peak Basketball to use my child's name/picture in connection with the promotion or undertaking of any Peak Basketball programs or activities, including without limitation on the website (www.peakbball.com) and in general marketing, promotional and advertising materials.
Clear selection
The player above is making a commitment to Team Peak and the team he/she is selected for and will maintain an active role on and for that team for the entire 2019-20 travel season. I commit to good sportsmanship towards teammates, coaches, opponents, and officials. I commit to working hard with a growth mindset, regardless of outcome. (Please print name below to make that commitment.) *
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