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Sign Up
CT Express Parent Guardian Form
Dear Parent/Guardian:
The CT Express Welcomes your child to our AAU basketball program. We hope that your child will find the exprerience rewarding and will develop skills and friendships that he or she will keep for the rest of his/her life.
Your child wll be placed on a team based on an assessment by the coaching staff using the following criteria: skills, ability, and basketball knowledge. Your child will automatically be placed on the team if there are only enough youth to form one team in your child's age divison. The ability of the team is then assessed by the staff and the team is placed for example in the appropriate tournaments, either (elite), (compettive) or (recreational).
As a condition of your child's participation in this activity, you must complete and submit the electronic form. If you do not want to authorize the CT Express to secure medical treatment for your child in the event of an accident and you cannot be contacted, then select the opt out button. Be sure, nonetheless, to complete the "Emergency and Medical Information" section.
Non-Refundable $200 deposit is requried with the submission of this form. You will be redirected to Paypal to securely make your deposit payment. Deposit secures players "ROSTER" spot on the team.
Child's Name
Age
DOB
Gender
Male
Female
School
Grade
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Parent's Name
Parent's Phone
Work Phone
Address
City
State
Zip
This form has four sections (1) an assumption of risk and release; (2) paragraph of instruction; (3) medical authorization; and (4) a participant information form. The first section tells you about risks of injury that may arise from participating in the CT Express basketball program. The second section emphasizes obedience to safety rules. The third section gives the CT Express authorization to provide medical care in case an accident should happen and you cannot be contacted. The fourth section provides the CT Express important information about your child.
As a parent or guardian, you should ask coaches, physicians, and other knowledgeable persons about any concerns that you might have at any time about your child's participation or safety. The decision for your child to participate is yous.
I. ASSUMPTION OF RISKS
Injuries to participants in the CT Express program may occur from risks inherent in the sports or activity; from placing stress on the body that has not been prepared for; from accidents in learning or practicing playing techniques; from failing to follow game, training, safety or other team rules; from the use of transportation to and from games and other events; and from administration of first aid. Injury can include direct physical, and possibly crippling, injury to one's body, and emotional injury experienced as a result of inflicting injury to another or witnessing it. The severity of injury can range from minor cuts, scrapes, or muscle strain to catastrophic injury, such as paralysis or even death.
In consideration of the CT Express permitting my child or ward to participate in its AAU basketball program, I hereby agree on the behalf of my child that he or she will assume the risk of injury or death from participating as outlined above. I release the CT Express, the department's employees, advisory councils, and/or volunteers from any liability resulting from my child's participating in the sport or activity. This assumption of risk and release binds by child's heirs, estate, executor or administrator, and assigns all members of my family.
II. INSTRUCTION
I have told my child to obey all directions of the instructors and personnel in charge of the sport or activity and their assistants; to comply with all safety instructions; and to refrain from horseplay and other unsafe practices.
III. MEDICAL AUTHORIZATION
In the case of an accident or illness, I authorize the CT Express to provide medical treatment for my child if I cannot be contacted immediately and I consent to the administration of any and all medical procedures deemed necessary by the attending authorities. I understand that the CT Express, its staff, and volunteers assume no financial obligations or liability for the immediate medical treatment that they provide to or for my child.
Medical Authorization
I Authorize
I do not authorize
If you do not authorize you still must complete emergency contact information!!
IV. EMERGENCY AND MEDICAL INFORMATION
Emergency Contact:
Contact Name
Daytime Phone
Evening Phone
Address
City
State
Zip
Alternate Emergency Contact:
Contact Name
Daytime Phone
Evening Phone
Address
City
State
Zip
Physician:
Physician's Name
Phone
Address
City
State
Zip
Allergies
Medications
Medical Conditions
Insurance Company
Policy #
Comments
I/We have agreed to assume the risks of participation and the release, given the instruction, authorized immediate medical attention if I/we cannot be contacted, and completed the emergency and medical information
By clicking the submit button you agree to all terms and conditions in this agreement.
Submit button
CT Express Waiver Form
Participant's Last Name
First Name
MI
DOB
Age
Gender
Male
Female
School
Grade
4th
5th
6th
7th
8th
9th
10th
11th
12th
Guardian's Name
Address
City
State
Zip
Home
Work
Mobile
Email Address
Emergency Contact
Relationship
Phone
Hospital Preference
Town
Physician's Name
Phone
Allergies
List allergies in the space below
Special Medical/Physical Conditions
List any medical conditions in the space below
Athlete's Waiver. Pledge and Consent Agreement While youths are responsible for their own behavior, as a parent and/or legal guardian, i remain legally liable for any actions or damages made by the above named minor. I am aware that I will be called if my child breaks any of the rules and has to be sent home. I agree on behalf of myself, my child named herein, our heirs, successors, and assign's to hold harmless and defend CT Express, its administrators, directors and representatives associated with my child attending this event or in connection with any illness or injury of cost of medical treatment in connection there with. I hearby warrant that to the best of my knowledge, my child is in good health and physical condition and he/she has no disease or injury that would restrict his/her participation in activities related to the CT Express. I assume all responsibility of the health of my child. In the event of an emergency and i cannot be reached, I hereby give permission to transport my child to a hospital or medical facility and to seek medical attention. By entering and participating in the CT Express organization, I agree to abide by the rules and regulations of the organization, administrators and coaches.
By clicking the submit button you agree to the terms and conditions.
Submit button