Register Form

MGBL Corporate Sponsor


REGISTER HERE


Parent Info

Parent First Name


Parent Last Name


Parent Cell Phone


Parent E-mail


Parent E-mail Alternate


Address 1


Address 2


City


State

Zip Code


How Many Children Are You Registering


Check if you would like to coach a team? (Not Guaranteed)


Check if you would like to be a Sponsor




Medical Info

Physician Name


Physician Phone Number


Insurance Carrier


Group #


ID #


Emergency Contact Name


Emergency Contact Phone Number


By clicking the following, I consent to the taking of photography and/or use of video clips of my child and its dissemination in certain media publications.

Waiver

I am aware that participation in athletics and recreation involves risk of personal injury including, but not limited to soft tissue injury and/or broken bones. Any use of facilities, equipment and programs of the Mitch Gross Basketball League and my child participating in such activities shall constitute acceptance of the risk regardless of the nature of the injury. I fully assume such risks and agree that the Mitch Gross Basketball League, its officers, agents and staff members shall not be liable for any loss or damage sustained by participating in the activities mentioned above at the Mitch Gross Basketball League whether caused directly or indirectly. In entering into this agreement, I am not relying upon any oral written representations of statements made by the Mitch Gross Basketball League, its officers, agents and staff members other than what is set forth in this agreement. I have read and fully understand the foregoing and represent that the information provided by me in this registration form is correct.

Check if they agree to the waiver