Tea Booster Club Tournament
Presented by
Xtreme Hoops Showcase
Tea, South Dakota
5 Minutes from Sioux Falls
Dec. 4th & 5th 2015 (Friday night & Saturday)
Team Name: _________________________________ Coach Name:____________________________
Contact Person:______________________________________ Phone:__________________________
Email:_______________________________________Address:______________________________
City/State:__________________________________________ Zip Code:_________________
BOYS OR
GIRLS
(circle one)
3rd & 4th,
5th,
6th,
7th,
8th
Team Skill Level: (1= Rec Team; 10= Elite Team) 1 2 3 4 5 6 7 8 9 10
Division Preferred: A or B
(circle one)
ENTRY FEE: $130.00
Make checks payable to:
Tea Booster Club
5204 S. Chinook Ave
Sioux Falls, SD 57108
You are not entered until we receive your payment.
LOCATION: Tea High School & Intermediate School,
On-Line Brackets and Live Updates!!!!!
REGISTRATION DEADLINE: Nov. 22, 2015 . (Will FILL FAST)
Questions: Please contact John at 605-940-6759 or email: teaboosterclub@gmail.com
Player Liability Waiver / Release may be brought to the event and must be submitted.
Schedules will be posted on tournament website approximately one week before the event.
Every effort will be made to place teams in competitive divisions. If weather causes cancellation, all
but $30 of the entry fee will be returned. We reserve the right to keep entry fee if team withdraws
after deadline of the tournament date.
Player – Parent Liability Waiver / Release Form
TEAM Name: _______________________________________ Coach / Team Rep: ________________________
I, the undersigned, release Xtreme Hoops Showcase & Tea Booster Club, its officers and committee members, volunteers and
officials, and the Tea School District or any of their officers, committee members, officials, volunteers or employees, from any and all
liability for any injury or loss sustained by any player while playing, practicing, traveling, and participating in the Xtreme Hoops
Showcase. The signing of this Player-Parent Liability Waiver Agreement shall be considered as a waiver of any claim for any such
injury or loss. If my child is injured and requires medical care, I consent to such care. All players and parents/guardians (if player is
under 18 years old) must sign this waiver form in order to be eligible to participate in this tournament / event. This form must be
submitted prior to the start of the first game.
Team Roster and Waiver Signatures
Player
Parent / Guardian Signature
Grade
1.______________________________________________________________
2.______________________________________________________________
3.______________________________________________________________
4.______________________________________________________________
5.______________________________________________________________
6.______________________________________________________________
7.______________________________________________________________
8.______________________________________________________________
9.______________________________________________________________
10._____________________________________________________________
TEAM PERMISSION AND RELEASE: I give permission, on behalf of players and their parents, for the above named
players to play in the Tea Booster Club Tournament I understand that Xtreme Hoops Showcase,
Tea School District along with anyone associate with these organizations have no responsibility, assumes none, and
do not carry accident insurance for the benefit of players. We release Xtreme Hoops Showcaseand Tea School District
from all claims of any injuries and lost or stolen property which may occur while participating in this event. I assume full
responsibility and completely understand this and verify all parents and guardians also clearly understand this.
Signature of Coach / Team Representative: _____________________________________ DATE: _________________
Registration Contact: John Van Stedum 605-940-6759 or email: teaboosterclub@gmail.com