Hoops Basketball 2019 Registration Form
Please fill out this form accurately for your child.
Email address *
Child's first name *
Your answer
Child's last name *
Your answer
Parent/Guardian #1 - First name (this will be considered the Emergency Contact for the child) *
Your answer
Parent/Guardian #1 - Last name *
Your answer
Parent/Guardian #1 - Cell phone # *
Your answer
Parent/Guardian #1 - Street address (where the child resides) *
Your answer
Parent/Guardian #1 - City *
Your answer
Parent/Guardian #1- State *
Your answer
Parent/Guardian #1- Zip code *
Your answer
Parent/Guardian #1 - Email address *
Your answer
Parent/Guardian #2 - First name
Your answer
Parent/Guardian #2 - Last name
Your answer
Parent/Guardian #2 - Cell phone #
Your answer
Child's gender *
Child's current grade in school *
Child's date of birth *
MM
/
DD
/
YYYY
Child's cell phone # (if applicable)
Your answer
Would you (as the parent) like to assist the league as a coach, co-coach, referee, or team parent? Please choose all that apply. *
Required
Does the child need a jersey? *
If the child is using the SAME JERSEY as LAST YEAR, what jersey # do they have? If your child needs a new jersey, please type "New" below. *
Your answer
If ordering a new jersey for this year, please indicate what size jersey your child needs. *
Release of Liability
Please read the following Release of Liability and check below that you have read, understand, and agree to this Release of Liability document.
Release of Liability - MUMC Hoops
By answering "Yes" below, I, as the parent/guardian of the child indicated on this form, have read, understand, and agree to the above Release of Liability provided by the Maumee United Methodist Church Hoops Basketball Program. *
A copy of your responses will be emailed to the address you provided.
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