Player's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Parent/Guardian's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact *

Please provide emergency contact information in case we are unable to reach you.

First Name

Last Name

Phone *

(###)

###

####

Photo permission

The league may occasionally post photos on websites or social media sites to help promote our activities. Please only check this box if you DO NOT want your child's photo to be used for promotional purposes.

I do not want my child's photo to be used

Release of Liability *

I/We as the parent(s) or legal guardian of the child listed on this registration, understand the above named child will be participating in this Holbrook Basketball Club (HBC). I/We release the HBC from any and all liability of whatever form which may arise as a result of any injury during the 2022/2023 season. I/We are giving the above said child permission to participate in the season and take full responsibility for said child.

Yes