Denair High Boy’s Basketball Alumni Game
Participant REGISTRATION FORM
DEADLINE TO SUBMIT FORM AND PAYMENT IS: SATURDAY, MAY 4th
(*Note - Please PRINT CLEARLY the address and information you would like to use as your mailing address for the next Alumni B-ball event!)
Name _____________________________________________________
Address ________________________________________
Home Phone (_______) ____________________
Jersey Size _________
HS Graduation Year ______________
City ___________
State _____
Zip Code _________
Cell Phone (_______) ______________________
E-Mail: _________________________________________________________
Liability Waiver and Release.
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I agree to participate in the Denair High School Basketball Game
conducted by Denair High School, Denair Unified School District, Denair High School employees, and Denair High Basketball Alumni Game event organizers/workers. I
understand that Denair High School, the basketball event organizers, and its workers will NOT be held responsible for any illness, injury (minimal, serious, catastrophic,
and/or death), or loss of property that occurs while attending and/or participating in Denair High Basketball Alumni Game and all activities associated with the event or
while traveling to and from the site for the event whether or not the event actually occurs. I do hereby waive and release Denair High School, Denair basketball and Alumni
Game organizers, it’s workers, and the Denair School District from any and all liability including claims and suits in law or equity for any injury, fatal or otherwise,
demands or actions that may subsequently be brought by me or by any other persons on the account of damages of any character resulting to me in any way from the
foregoing activities. I also understand that Denair High School and Denair High Alumni Basketball and Game organizers and workers retain the right to use, for publicity
and advertising purposes, photographs of participants taken during the Denair High Alumni Basketball Game.
Medical Release.
I realize the risk(s) involved as a participant. A recent physical examination of me indicates no reason that I should not participate in the Denair High Alumni Basketball
Game activities, nor have I any knowledge of any physical impairment that can limit the above named participant. I authorize Denair High Basketball and Alumni
organizers and workers or Denair High faculty to obtain necessary medical treatment for me and hereby release and hold harmless Releases in the exercises of this authority.
I will pay, or cover through my insurance, any medical or hospital expenses, the doctor bills, and any other expenses, which could result while participating in the Denair
High Alumni Basketball Game or its activities.
Game Rules.
I further acknowledge and understand that Denair High has established rules and regulations pertaining to conduct, behavior and activities of all Denair High School
Basketball Alumni Game participants by which I agree to abide during the event, and that I will be responsible for my failure to abide by those rules and regulations. I have
received, read and understand the event rules. I understand that violation of the rules can result in dismissal from event with NO refund. I agree to comply with the list of
rules set for the event by the Denair High Alumni Basketball organizers.
Insurance and Medical Information.
I represent that any medication to which I am allergic or medications that I am currently taking are listed below. I agree that I shall bring medications which I am currently
taking with me to the event and that I shall consume the prescribed dosage for such medications. Denair High Basketball organizers/workers will not administer or
supply any type of medication at the event.
Medications (if any): _________________________________________________________________________________________________________
Allergic to (if any):___________________________________________________________________________________________________________
I acknowledge that I suffer from the following conditions: ___________________________________________________________________________
Family Doctor: __________________________________________ Phone Number: ( )_____________________ Your Birthdate: _____/_____/_______
Medical and/or Hospital Insurance Company: _____________________________________________________________________________
Policy Holder: _______________________ Policy #_________________________ Group #: ____________________________________
In an emergency, please contact:
Name: ______________________________________________ Home Phone: __________________Cell Phone: ___________________
Name: ______________________________________________Home Phone: __________________ Cell Phone: ___________________
I hereby warrant that I have read this registration form in its entirety and fully understand its contents. I am aware that this registration form releases Denair High School,
Denair Unified School District, Denair High School employees, and Denair High School Basketball Alumni Game organizers/workers from liability and contains an
acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I further acknowledge that nothing in this registration form constitutes a
guarantee that the event will occur. I have signed this document voluntarily and of my own free will.
X Signature: ___________________________________________________________________
Date: __________________
*** Registration Fee: $30.00 (Cash or Check)
Please attach your payment to this form. Make checks out to ‘Denair High Boy’s Basketball.
This payment will go towards your t-shirt for the event and the rest will be a donation to the basketball program.
(KEEP THIS FORM)
Denair High Alumni Basketball/Cheer Game
Participant INFORMATION
Date: Saturday, May 18th 2013
Time: (Please arrive an hour before your game starts)
Boys Alumni Semifinal Game 1: 6pm
Boys Alumni Semifinal Game 2: 7pm
Boys Alumni Final: 8pm
Place: Denair High School Gym
Practices: You will be contacted by one of the event organizers about any open gyms or
practices that will be held prior to the event.
*Hand deliver or mail the registration form and $30 payment to:
Denair High School
Attn: DHS Boy’s Basketball
3460 Lester Road
Denair Ca 95316
*Any questions? Ask your Organizer:
DHS Boys Basketball Alumni Contact: RJ Henderson
Email: rhenderson@dusd.k12.ca.us
*Did You Do The Following?:
Turn in your $30 payment and filled out registration form into the DHS front office or
your contact person ( RJ Henderson) no later than Saturday, May 4th.
Tell all your family, friends, and other DHS Alumni to come watch and support our DHS b-ball
program!
It is the Denair High Basketball Alumni Game Organizers responsibility to: Give you the
list of rules/regulations for the event, give you your complimentary jersey to wear for the
game, and let you know if any practice times get scheduled!
Thank you and I hope to see you at the DHS Alumni event on
Saturday, May 18th!!!
The goal is to get 4 teams of 8+ players. Those teams would
be separated by years of graduation. Players must have
played varsity basketball at Denair. Once the players commit
I will breakdown years that players will participate in. Id like
to do a flyer at the door with past info of everyone
participating. Let me know if you have any questions
------------------------------------------------Basketball Fact Sheet
Name:
Years you played @ DHS & who was your coach?:
Any awards you received in basketball while you were playing?:
Any post high school basketball or any other sport played & what college?:
What are you doing now?:
Any other interesting fact you would like to share (can be anything athletic or
life related)?:
Denair HIGH
BASKETBALL ALUMNI GAME
TO DO LIST:
 Fill out the participant Registration Form!
 Pay your $30 (Checks can be written out
to Denair Boys Basketball)
 Take home the Participant Information
Form!
 If you have Facebook, spread the word
amongst alum