Registration

Player Information

Player Name *

Player Gender *

Male

Female

Player Age *

As of September 1, 2020

Player Birthdate *

Player Grade *

Player Email *

Player Phone *

Player Allergies

Player Eligibility: Is this player eligible to play basketball under the NCHC rules? *

Yes

No

NCHC Rules: http://nchclive.com/guidelines/

Player Eligibility: If your high school basketball player is transferring from a public or private school, you are required to meet with Round Rock Raiders leadership before your player will be allowed to participate in any games. Is your player a high school student transferring from a public or private school? *

Yes

No

Player Eligibility: In accordance with the NCHC requirements, do you commit to making sure your student maintains a 2.0 GPA (on a 4-point scale) during the basketball season? *

Yes

No

Parent 1 Information

Parent 1 Name *

Parent 1 Email *

Parent 1 Phone *

Parent 1 Address *

Parent 1 Address

City

State/Province

Zip/Postal

Country

Parent 2 Information

Parent 2 Name

Parent 2 Email

Parent 2 Phone

Parent 2 Address

City

State/Province

Zip/Postal

Country

Other Information

Emergency Contact Name *

Emergency Contact Relationship to Player *

Emergency Contact Phone *

Health Insurance Carrier *

Health Insurance Policy Number *

Primary Care Physician *

Primary Care Physician Phone *

Consent to Treat

As parent/legal guardian of the child named herein, I hereby give permission to the Round Rock Raiders (R3) organization, its officers, agents, trainers, coaches or volunteers to take whatever action is necessary for the health and welfare of my child, including consenting on my behalf to any and all medical treatments, procedures, operations and/or hospitalizations.
I further agree to indemnify and hold harmless the Round Rock Raiders organization, R3 Basketball, as well as its officers, agents, trainers, coaches, or volunteers from any and all liability, damage, or expense arising out of my child’s participation in any R3 Basketball activity.
I understand there are inherent risks to participating in this athletic program. I hereby accept responsibility for and agree to pay any and all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation in the R3 Basketball Program.
My consent to treat and release is valid until March 31, 2020.
A parent or legal guardian must sign below indicating agreement to the above Consent to Treat and Release statement before player is accepted to participate in R3 Basketball activities.

Consent Signature *

Your typed name will act as your signature

Volunteering Commitment

Because the Round Rock Raiders are a non-profit organization, we ask each family to volunteer to help in at least two areas.

2020-2021 Basketball Registration Form

Player Information

Parent 1 Information

Parent 2 Information

Other Information

Consent to Treat

Volunteering Commitment

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