o Registration Fee = $1,695.00 Paid? YES NO
Check #__________Cash: ___________ APP: ____________
Registration Fee Includes: ALL (Tournament Fee, Trainer Fees, Coaching Fees, Gym Rental Fees and
Uniform Package fees) one-time payment covers all 5 months and games
o Uniform Package = Reversible Game Jersey, Reversible Game Shorts, (2) Shooting Shirts (a long sleeve
and a short sleeve), Hoody, game socks, Practice Shorts and Reversible Practice Jersey
IMPORTANT: ALL Players MUST have an AAU card with Extended Benefits Coverage: This Membership
Card will need to be purchased separately at www.backcourt-hoops.net and click accreditation TAB click AAU
Go to www.AAUsports.org purchase AAU membership (Youth Athlete with Extended Benefits. Please
bring a copy of the AAU with Extended Benefits Membership Card to your first practice.
Payment is due at the first practice following acceptance email we will send to players. (Personal
checks payable to: BACKCOURT HOOPS) / we do accept CASHAPP or CASH as well
PLAYER NAME: _________________________________ _______________________________________
BIRTH DATE: (mm/dd/yyyy) _______________________ GRADE: __________ AGE: _________________
PLAYING EXPERIENCE: YMCA: _________ UPWARD: ________ OTHER Programs: _________
PLAYER CELL PHONE: __________________ PLAYER EMAIL: ______________________________
PARENT / GUARDIAN #1 NAME: ______________________________CELL PHONE: __________________
PARENT / GUARDIAN #2 NAME: ______________________________CELL PHONE: __________________
EMAIL #2: ____________________________________________________________________________
PARENTAL CONSENT FORM The unsigned, being a parent or legal guardian of the child requesting program admittance, does hereby affirm the applicant is in good
health, and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclose or approved.
Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity. The undersigned hereby expressly
agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to the
allowing of BACKCOURT HOOPS program supervision to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent.
Neither BACKCOURT HOOPS, nor other participating BACKCOURT HOOPS facilities provide primary medical insurance. I understand that, as a condition of
admittance as a player, the undersigned, on behalf of all parents, and on behalf of the applicant, hereby releases BACKCOURT HOOPS, all participating BACKCOURT
HOOPS facilities, and all other coaches, employees, or agents of the organization from any and all liability from injury or illness, mental or physical, suffered by the
player during or related to the program, unless caused by willful act or gross negligence by the person or entity against whom the claim is made. I also authorize the
use of player photos & videos for all business and marketing purposes regarded appropriate by BACKCOURT HOOPS. I understand posting player photos & videos on
the worldwide web or social media may involve misuse by individuals outside the organization. We do not offer any REFUNDS for any reason.
This is the _______ day of ___________, 202____.
PARENT / GUARDIAN NAME (Print): ______________________________________________________