Indiana Basketball Academy

Registration Form

Name (Participant)_________________________________________________________

Address __________________________________________________________________

City______________________________State_________________ Zip_______________

Home Phone___________________________Day Phone___________________________

Participant Birth Date_____________________ Team Name_________________________

Parent/Guardian___________________________________________________________

Emergency Contact Person___________________________________________________

Home Phone______________________________________________________________
Day Phone_______________________________________________________________

Relation _________________________________________________________________

League (please circle one):         Summer               Fall                   Winter                   Spring

Behavior Agreement

Participants agrees to abide by all rules, regulations, and amendments to such, as established by the Indiana Basketball Academy which rules shall be enforced at the sole discretion of the Indiana Basketball Academy.  Failure to abide by such rules and regulations may  result in termination of participants right to participate or attend any activity of the Indiana Basketball Academy.

Signature (participant/parent/guardian)_____________________________________________________________

Release For Participation

I the undersigned, realizing that there is a risk inherent in any recreational activity, and in consideration of my child being allowed to participate in this activity, I personally assume all risks for myself or my child in connection with the said event. I further agree to release, indemnify, and hold harmless the Indiana Basketball Academy, Inc, its officers, officials, coaches, employees, and agents from any and all claims and liabilities of any type whatsoever, and for damages to loss or destruction of any property or injury, sickness, or death which may now or hereafter arise out of, result from, or in any way be connected with my child's participation in said activity. I understand it is my responsibility to obtain health insurance. I acknowledge that the Indiana Basketball Academy, Inc may utilize my name or my child's name, address, and likeness and hereby waive all rights to compensation for their use in the promotion and operation of the Indiana Basketball Academy, Inc. I further state that I am of lawful age and legally competent to sign this release; that I understand the terms herein are contractual and are not mere recital; and that I have signed this document of my own free act.

Signature (player)_________________________________________________________________________

                                                                            (under 18 must have parent/guardian signature)

Signature (parent/guardian) __________________________________________________________________

Date__________________

Back to schedule :: playIBA.com :: - IBA Schedules - : 

Back to main page:: playIBA.com :: - Welcome to playIBA.com - :