Riverside Brookfield 5th/6th & 7th/8th Grade Summer League Registration
Please complete all sections below to register for either the 5th/6th OR 7th/8th Summer League. Once your registration form is submitted, you will receive an email confirmation with payment information. PLEASE print the email and mail it in with your payment ASAP! Only the first 100 who are registered AND paid will be allowed to participate!

Please remember this is for the grade your son will be in starting the fall of 2019.

2019 Summer League Dates:
Wednesday: June 26, 2019
Four Tuesdays: July 9, July 16, July 23, and July 30

Location:
Riverside Brookfield High School

Time:
5th/6th Grade 6:00pm and 6:50pm (please arrive at 5:30 on Wednesday, June 26th for check-in)
7th/8th Grade 7:45 and 8:40pm (please arrive at 7:15 on Wednesday, June 26th for check-in)

Part 1 of 4: Player and Family Information
Please fill out all applicable information below. Questions marked with a red star are required information.
Player Last Name *
Your answer
Player First Name *
Your answer
Grade (as of Fall 2019) *
School Player Attends (Fall of 2019) *
Reversible Jersey Size *
All Adult Sizes
Parent Name(s) *
Your answer
Primary Phone Number *
(please use 123-456-7890 format with dashes)
Your answer
Preferred Parent Cell Phone Number *
(please use 123-456-7890 format with dashes)
Your answer
Additional Parent Cell Phone Number
(please use 123-456-7890 format with dashes)
Your answer
Player Cell Phone Number
(please use 123-456-7890 format with dashes)
Your answer
Preferred Contact Email *
Your answer
Additional Contact Email
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone Number *
(please use 123-456-7890 format with dashes)
Your answer
If you know you are unable to attend on any of the scheduled dates, please indicate the date(s) below *
If your plans change, please contact Mike Reingruber at coachgrube30@hotmail.com with the date(s) you will be unable to attend
Required
Part 4 of 4: Riverside Brookfield Basketball Waiver and Release of All Claims
Please read this form carefully and be aware that in signing up and participating in this program, you will be waiving and releasing all claims for injuries, you might sustain arising out of this program.

The parents/guardians of the above named participant hereby give our full permission for the participant to participate in Riverside Brookfield High School (the “Program”). The participant and parent/guardian of the participant recognize and acknowledge that there are certain risks of physical injury and agree to assume the full risk of any injuries, including death, damages, or losses which the participant and/or parent/guardian may sustain as a result of participation in any and all activities connected with or associated with the Program.

The participant and parent/guardian of the participant do hereby fully release and discharge Riverside Brookfield High School District, including the Board of Education, and Riverside Brookfield Basketball staff, its members, employees, agents, and volunteers from any and all claims from injuries, including death, damages, or losses which the participant and/or parent/guardian of the participant may have or which may accrue on account of participation in the Program.

The parent/guardian of the participant further agrees to indemnify and hold harmless and defend Riverside Brookfield High School District, including the Board of Education, and Riverside Brookfield Basketball staff, its members, employees, agents, and volunteers from any and all claims resulting from injuries, including death, damages, and losses sustained by the parent/guardian or the above participant and arising out of, connected with, or in any way associated with the activities of the Program.

It is the express intent of the participant and parent/guardian of the participant that this waiver and release shall bind the members of their family, their spouse, their heirs, assigns, and personal representatives and shall be deemed as a release, waiver, discharge, and covenant not to sue Riverside Brookfield High School District.

In the event of an emergency, the parent/guardian of the participant authorizes Riverside Brookfield High School and/or Riverside Brookfield Bulldogs Basketball staff to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for participant’s immediate care and agree that parent/guardian will be responsible for payment of any and all medical services rendered.

If any term, covenant, condition, or provision of this waiver and release is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remainder of the provisions shall remain in full force and effect and shall in no way be affected, impaired, or invalidated.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE PROGRAM DETAILS AND WAIVER AND RELEASE OF ALL CLAIMS *
Please check below
Required
Type Parent Name for Waiver and Release of All Claims *
This represents your signature
Your answer
Date Signed Waiver and Release of All Claims *
MM
/
DD
/
YYYY
Finalize Registration

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