Campbell Junior Basketball Try-Out Pre-Registration Form
This is the pre-registration form. You will still be required to sign a medical release at tryouts.
Email address *
Player's Name *
Your answer
Gender & Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
GIRL
BOY
Player's School *
Player's Full Address With Zip Code *
Your answer
Player's Birth Date *
MM
/
DD
/
YYYY
Player's Cell Number
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Cell Number *
Your answer
Additional Parent/Guardian Name
Your answer
Additional Parent/Guardian Cell Number
Your answer
Additional Parent/Guardian Email Address
Your answer
To be notified in case of emergency (name & phone #) *
Your answer
Insurance Company & Policy Number *
Your answer
Is Tetanus shot current? *
Allergies or physical concerns staff should be aware of
Your answer
I hereby authorize medical treatment for (players name) *
Your answer
Please Read and Sign the Following Statement: I recognize there are inherent risks involved in this sport activity. In consideration of the services provided, I hereby release and hold harmless Cobb County, Cobb County Schools, Campbell Junior Basketball Program and coaches, City of Smyrna, and its directors, employees and agents from any and all liability for injuries, including those resulting in death, and illnesses incurred while attending basketball sessions or events or occurring as a result of having attended any basketball sessions or events. I certify that my child is in good health and is able to participate in all program activities. Furthermore, in the event of an emergency requiring medical attention, I shall pay for the services rendered. (to be signed at tryouts!)
Date/Parent Signature:
Your answer
Please arrive at least 15 minutes before your designated try-out time. Visit campbelljuniorbasketball.com for more information!
A copy of your responses will be emailed to the address you provided.
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