1
UNITED STATES BASKETBALL ASSOCIATION
Parental Consent and Insurance Waiver
By signing below I grant permission for my son/daughter to participate in the
United States Basketball Association (USBA). My child has no known medical
conditions that would prevent them from participating in
competitive, strenuous basketball activities.
I release the United States Basketball Association (USBA), and their officers from
any legal responsibility in the event of an accident, injury, or death involving my
son or daughter while participating in ANY USBA sanctioned event.
If needed, I give USBA permission to use my child’s picture on material
related to USBA, and their events. This would include, but not limited to
brochures, flyers, website, etc.
Name of Player:___________________________Birthdate:_____/____/___
Address:______________________________________________________
City:________________St.______________Phone____________________
E-mail address:________________________________________________
Signed:
Mother(LegalGuardian)_____________________________Date___/___/____
Father(Legal Guardian)______________________________Date___/___/____
Coaches Note: A waiver must be completed for every player and be in your
possession at all USBA tournaments. Tournament officials will check for all forms.
You DO NOT need to send these to the USBA office.
PDF created with pdfFactory trial version www.pdffactory.com
2
USBA GRADE EXCEPTION FORM
Team Name_____________________________Age Group_____________
Team Address:__________________________State._________Zip____________
Coach’s Name______________________Coach’s Phone_______________
Player’s Name_________________________________________________
Player’s Birthdate____________________Current Grade_______________
Current School
Name________________________________State._____________
Principal of Current School (please print)_______________________________________
Current School Phone Number (include area code)_______________________________
My signature below certifies that the player listed above is currently in the_______ grade.
Principal’s
Signature__________________________________Date________________
Please have this form with you at all USBA tournaments. You do not need
to send this to the USBA office.
PDF created with pdfFactory trial version www.pdffactory.com
3
Fayetteville Pistons
Accident Waiver and Release of Liability Form
Check All That May Apply: Sports Training___
Sports Competition/Tournament ____
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of
example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from
dangerous or defective equipment or property owned, maintained, or controlled by t hem, or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not
participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation
in this activity or event.
I acknowledge that this Accident Waiver and Release of Liability Form will be used b the event holders, sponsors, coaches, and organizers of the
activity or event in which I am participate, and that it will govern my actions and responsibilities at said activity or event.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators,
heirs, next of kin, successors, and assigns as follows:
(A)
I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or
fault of the entities or persons released for my death, disability, personal injury, property damage, property theft, or actions of any
kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Life
Changing Athletics and/or their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders,
activity or event sponsors, activity or event volunteers.
(B)
I INDEMIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all
liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or
otherwise.
I acknowledge that Life Changing Athletics and their directors, officers, volunteers, representatives, and agents are NOT responsible for the
errors, omissions, acts, or failure to act of any party or entity conducting a specific event or activity on behalf of Life Changing Athletics.
I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for
death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain. facilities, temperature, weather,
condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators,
coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to
participants, but are also present for volunteers.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this
activity or event.
4
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any
legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.
The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible
under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A
RELEASE OF LIABILITY AND CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
_____________________________
________
__________________________________
Print Participant’s Name
Age
Signature
(If under 18 years old, Parent or Guardian must also sign)
_____________
Date
5
Fayetteville Pistons
ATHLETICS WAIVER AND RELEASE FORM
CHILD INFORMATION
Child’s First Name: ______________________ Child’s Last Name: ______________________________
Child’s Date of Birth: _________________ Nick Name (If any): ________________________________
Child’s Address: ________________________________________________________________________
City: ___________________________ State: ____________ Zip: _______________________
Home Phone: _____________________________ Cell Phone: _________________________________
Child’s First Name: ______________________ Child’s Last Name: ______________________________
Child’s Date of Birth: _________________ Nick Name (If any): ________________________________
Child’s Address: ________________________________________________________________________
City: ___________________________ State: ____________ Zip: _______________________
Home Phone: _____________________________ Cell Phone: _________________________________
PARENT INFORMATION
Mother’s First Name: _____________________ / Last Name: _____________________
Father’s First Name: _____________________ / Last Name: ______________________
Mother’s Cell Phone: _________________ / Father’s Cell Phone: ______________
************************************************************************
Emergency Contact Name: _________________________________________
Emergency Contact Number: _______________________________________
6
7
2011 AAU BOYS’ BASKETBALL GRADE EXCEPTION FORM
THIS IS A MASTER FORM - MAKE COPIES AS NEEDED
This form must be completed and attached to each player’s birth certificate that is competing under the
grade exception rule. An administrator of the player’s school must sign the form.
NOTE: All information is necessary for proper identification. Player will be rejected if information is
incomplete.
CLUB/TEAM NAME:
____________________________________________________________________
AGE/GRADE DIVISION:
_________________________________________________________________
PLAYER NAME:
________________________________________________________________________
PLAYER ADDRESSES:
__________________________________________________________________
PLAYER PHONE NUMBER: __________________________Email:
______________________________
SCHOOL ATTENDING 2009-2010:
________________________________________________________
SCHOOL ADDRESS:
____________________________________________________________________
________________________________________________________
_____________________________
CITY/STATE ZIP
SCHOOL PHONE NUMBER: ____________________________Email:
___________________________
This is to certify that as of 3/1/10______________________________________was attending the
school listed
above and was in the ____________grade.
_____________________________________ __________________________________
SCHOOL ADMINISTRATOR SIGNATURE SCHOOL ADMINISTRATOR POSITION
8
2011 REGISTRATION FORM
NAME___________________________ ____DOB___/___/___ CURRENT GRADE _____
ADDRESS________________________________CITY/STATE/ZIP __________________
TEL # (Home)______________________(Cell)____________________
EMAIL __________________________@_______________(PARENT)
EMAIL_________________________@_________________(PLAYER)
SCHOOL_______________________ HIGH SCHOOL TEAM LEVEL Varsity JV Freshman
CYO and/or WINTER LEAGUE TEAM____________________________________________
AGE GROUP TRYING OUT FOR_________________________________________________
PARENT/GUARDIAN______________________INSURANCE CARRIER________________
MEDCIAL PROBLEMS_________________________________________________________
ADULT UNIFORM SIZE________ POSITION PLAYED________
PLAYER FEE: $175.00
To pay by credit card: ____Visa ____Mastercard Card #____________________________
Expiration Date___/___ V code_____ Cardholder Signature__________________________
Please read and sign below:
I give my permission for ______________________________ to participate in the TCA Fayetteville Pistons
programs. Parental signature below
signifies that each person has read, understands and abides by this information. There are risks connected with the
possibility of physical injury
associated with basketball and in consideration for the TCA Fayetteville Pistons (TCA) accepting this registrant for
its program and activities (the
Programs), hereby release, waive, discharge and covenant not to sue TCA and/or otherwise indemnify TCA, its
affiliated organizations and sponsors, their employees, coaches, association personnel, including the owners of
gyms, facilities, and referees utilized for the Programs, against any claim or on behalf of the registrant as a result of
the registrant’s participation in the Programs, and/or being transported to or from the same, which transportation I
hereby authorize. My daughter and I have read and understand the attached registration and tryout information and
agree to the terms therein.
Parent/Guardian signature____________________________________________________________________
9
2011 Player/Parent Contract
This PLAYER / PARENT CONTRACT made by and between TCA Organization and
_____________________________ (“Player”) and ____________________________(“Parent”) is
for the purpose of securing a spot on the TCA traveling basketball team roster for the 2011 AAU
Season. For consideration given, the Pistons, Player, and Parent do hereby agree as follows:
PLEASE INITIAL BESIDE EACH SUB-NOTE BELOW
(1) Waiver and Release – That the Player and Parent agree a Waiver and Release will be executed
and become a part of the Player Contract.
(2) Medical Release – That the Player and Parent agree a Medical Release will be executed
and used in the event of a medical emergency and become part of this Player Contract.
(3) Basketball Season – For purposes of this Player Contract (“Contract”), the Piston season
shall be from August 1, 2011 thru and including the conclusion of the season at the end
of October and/or November 2011.
(4) AAU / Other Organizations – The TCA Pistons are organized and sanctioned under
rules and regulations of various organizations, to include the Amateur Athletic Union
(“AAU”, USSSA, USBA, YBOA) and other national organizations. Players will be
expected to become members of each organization. If the Pistons should participate in a
2012 AAU basketball event, each Player shall be required to obtain an AAU
membership.
(5) Player Fees – That the Parent understands that there are certain and specific player fees,
which are required, in order to participate with the TCA Pistons Organization.
A Monthly Membership – Each Player shall pay an initial membership fee of Two
Hundred and Fifty Dollars ($175.00), which is non-refundable.
i. Payment covers: Tournament Uniforms, Shooting shirt, Bags,
ii. Also includes AAU Annual Membership and
(6) Uniforms and other TCA Pistons – The issuance of any and all uniforms previously
belonging to the Pistons Organization shall remain the exclusive property of the TCA
Pistons Organization and shall be returned in good condition (except any normal wear
and tear) within seven (7) days of the completion of the playing season or within seven
(7) days of any early termination.
a. TCA Pistons, such as uniforms on loan, will be subject to a loss and/or damage fee
not to exceed $50.00
i. Note – The Player agrees to properly care for and maintain all equipment
and uniforms provided to the Player by the TCA Pistons. The Player fully
understands that these items are the property of the TCA Pistons and are
10
to be returned in good condition upon request. The Player and Parent both
further understand that the Player is responsible for excessive damage to
the said equipment and uniforms.
- 1 - Initial_______________ - 2 - Initial_______________
b. For property issued in 5.a.i , as listed above, those items shall all remain the
property of the player with the following conditions:
i. The Player agrees to properly care for and maintain all equipment issued
to him/her
ii. All issued equipment in 5.a.i is a requirement, therefore any lost or
damaged equipment beyond repairable use must be replaced at the
Player’s expense within seven (7 ) days of notification.
c. Replacement Uniforms – The TCA Pistons reserve final rights in determining the
condition of any TCA Pistons Property and/or Standard Equipment Issued (see
5.a.i). Therefore, if at any time the condition of equipment and/or uniforms
administered to the Player are deemed un-satisfactory it will be the Player and
Parent responsibility to replace the Property within seven (7) days of notification
by the Organization. These fees are subject to change and will be discussed on a
per occurrence basis
(7) Rules and Regulations – The Player understands and agrees to comply with any and all
rules and regulations, which are promulgated from time-to-time by the TCA Pistons
Organization. Any violation of the said rules and regulations may cause the Player to be
suspended and/or dismissed from the team.
a. Missed practices & Tournaments – Attendance at events is important to the TCA
Pistons and the other players. As such, all players are expected to attend all
events. All players should arrive to practice on time and ready to work. The
TEAM is counting on you and suffers when all are not in attendance. If a player
continues to be late to practice without explanation, his playing time may be
reduced and can lead to removal from the team.
b. Playing Time – The Player and Parent understand that the TCA Pistons coaching
staff does not promise playing time to any player. In addition to this, the Player
and Parent understand that the stands, team dinners, hotels, or parking lots at a
tournament game are not the time to discuss this issue. The proper time to discuss
playing time is before a practice or after a practice- preferably a pre-scheduled
time. It is our philosophy that each player must earn his time on the court by
competing for a starting position and demonstrating teamwork and sportsmanship
both on and off the court.
c. Additional Players – The Player and Parent understand that if there’s a need to fill
a certain position on the team to compete, coaches may exercise their authority to
pick-up additional players to add onto the roster.
(8) Sportsmanship and Academics – The parent and Player understand and agree that
undermining the coaches at practice or games does not promote a positive atmosphere for
our program. All coaches in the TCA Pistons Organization are volunteers and are giving
their time and talent so that our children develop to the next level of playing. The
following guidelines have been established to ensure that each Player is successful both
on and off the court:
11
a. Academics – Each player will submit monthly progress reports from their teachers
indicating their academic progress during the school year. This progress report
will be reviewed by your team coach only, respecting the privacy of each Player.
The progress report will be either mailed to your home or emailed as an
attachment and expected to be turned in within one week.
i. A negative report or and indicated area of struggle does not necessarily
mean a Player cannot participate in activities. It does, however, allow the
coach to gage a Players Academic Success and determine if additional
assistance should be suggested in an area.
ii. Misconduct reports from school will not be tolerated. These incidents
will be discussed directly with the Parent and possible the Player.
- 3 - Initial_______________
iii. Players are expected to turn in all homework assignment on time and in
an orderly fashion.
iv. Players are expected to obey the rules and regulations of their schools,
teachers, and other staff members. They are also expected to respect all
teachers, janitors, cafeteria workers, bus drivers, and fellow students at all
times.
b. Sportsmanship – The Player and Parents understand that they need to respect all of
the members, players, parents, fans, and coaches of the TCA Pistons
Organization. We will also respect all referees or opposing teams at all times. If a
Player or Parent fails to behave accordingly, the TCA Pistons Staff reserves the
right to ask you to leave or sit a player on the bench. This is not a situation that
we like to arise, so please at all times maintain the reputation that we have all
worked hard to establish.
(9) Fundraisers – Each player and Parent will be expected to participate in scheduled
fundraisers, which will be used to help lower the costs for specific events.
(10) Insurance – Each player agrees to maintain a separate “insurance” policy, which shall
cover the player during all activities with the TCA Pistons Organization. A separate
“Waiver and Release” will be required to be signed prior to physical participation.
(11) Further Agreements – I certify that all information provided in the Player Contract is
accurate. This includes my name, address, date of birth. I hereby submit a satisfactory
birth document that is acceptable to the national affiliate with which this team intends to
advance for post season tournament play. If requested by a league officer, I will submit
an original notarized record of birth from the Bureau of Vital Statistics from the
state/city/county of my birth. I understand I am not eligible to participate in any league
games without having submitted an accurate TCA Pistons Release of Liability Form
signed and dated.
Address: ________________________________
________________________________
Phone: ________________ or _____________
Email: ________________________________
I further agree to abide by all TCA Pistons Organization, League, and/or National
Association rules.
Player Parent
_________________________________ _________________________________
12
Signature of Player Signature of Parent
___________________ ____________________
Date
Witness and Accepted by: ______________________________________
Date: _______________________
13
14