MVP Basketball 2018 at CCPC
Fill out a form for each child participating from your family. MVP Fee is $70 per child with a $140 family cap. Payment for all children may be made at one time after you submit this form. You will be directed to a secure online site.
First Name *
Child's First Name
Your answer
Last Name *
Child's Last Name
Your answer
Grade 2017-2018 *
School
Child attends what school
Your answer
Does the participant have a church home?
Home Address
### Street, City, State, Zip
Your answer
Child's Date of Birth *
MM
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Please list any known medical conditions
Your answer
Parent/Guardian 1 - Name (Emergency Contact) *
First and Last (This parent/guardian will be listed as the emergency contact)
Your answer
Parent/Guardian 1 - Mobile # *
Your answer
OK To send Text Messages to Parent/Guardian 1 Mobile?
Parent/Guardian 1 - Email Address *
Your answer
Parent/Guardian 2 - Name
First and Last
Your answer
Parent/Guardian 2 - Mobile #
Your answer
OK To send Text Messages to Parent/Guardian 2 Mobile?
Parent/Guardian 2 - Email Address *
Your answer
Student's Gender *
Friday Night Fundamentals
This is a division for girls in 3rd and 4th grade only. This is a 6-week fundamental skill development program that will be held on Friday evenings starting February 2 and going through March 9. There are no games on Saturday for this division.
The goal is to develop skills for girls with drills and instruction in a clinic-style setting with coaches who will provide more focused attention on the fundamentals of basketball. (3rd & 4th grade girls wanting to play in the regular co-ed league should not choose the Friday Night Fundamentals option.)
Child's skill level (relative to classmates)
If You choose ADVANCED, your child may be moved to another level.
List the name of one player you'd like as a teammate
(They must choose you as well)
Your answer
Which weekday afternoon/evening can your child NOT practice
Jersey Size (Same style as last year) *
YS
YM
YL
AS
AM
AL
AXL
A2X
Shirt Size
Shorts Size (Same style as last year) *
YS
YM
YL
AS
AM
AL
AXL
A2X
Shorts Size
Are you willing to serve as a Coach?
Which weekday afternoon/evening are you NOT able to coach?
Check all that apply
Release of Liability/Hold Harmless Agreement *
The Parent or Legal Guardian, in consideration of the acceptance of their child as a participant in the activity sponsored by Central College Presbyterian Church (CCPC) does hereby: 1. Agree to assume any and all risks and facilities incidental to the child’s participation; 2. Agree to indemnify, defend and hold CCPC, its trustees, staff members, Elders, Coaches and officials harmless from and against any claim or demand, and from liability for any injury or property damage; 3. Acknowledge and understand that no medical insurance is maintained by CCPC; such insurance being the sole responsibility of each participant family; and 4. Agree that all known medical health conditions have been disclosed to CCPC on this form
Required
Person Agreeing to Release of Liability/Hold Harmless Agreement *
First and Last Name
Your answer
Lindsay's Law
Lindsay's Law is about Sudden Cardiac Arrest(SCA) in youth athletes. The law went into effect in 2017. SCA is the leading cause of death in student athletes 19 years of age or younger. SCA occurs when the heart suddenly and unexpectedly stops beating. This cuts off blood flow to the brain and other vital organs. SCA is fatal if not treated immediately.

Lindsay's Law requires both the youth athlete and parent/guardian to acknowledge receipt of information about Sudden Cardiac arrest by signing a form. You can find this form at https://www.odh.ohio.gov/landing/Lindsays-Law.aspx

Lindsay's Law Form *
Required
Today's Date *
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