Registration Registration Information Father's First Name Father's Last Name Mother's First Name Mother's Last Name Parent Contact Name * Parent Phone * Parent Email * Parent Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Parent Participation * Coach Asst. Coach Scorekeeper Timekeeper Hall Monitor None Which Parent? Coaches CPR/AED Certified * Yes No Non Participation Fee Check this if parent participation is none - $25 Number of Children being Registered * 1 - $225 2 - $425 3 - $625 4 - $825 Total $ Amount To register multiple children, please click the add button under the first child information Child Information Parent Contact Name Parent Phone Parent Email Child First Name * Child Last Name * Birthdate * Age * 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Grade * 2 3 4 5 6 7 8 9 10 11 12 Sex * Boy Girl Height Weight School * Shirt Size * Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL Previous Experience * Yes No # Seasons Played Previous Coach/Team Physical Handicaps (please specify) Coach Requests/Car Pool Requests Choose if you will be a coach or asst coach for this child Coach Asst Coach Neither To register another child, please click the add button below Add Remove Permission I hereby give permission for registrant to participate in the current Northport/East Nothport Basketball Program. Unless I have otherwise indicated, there are no physical disabilities which would prevent him/her from participating in this program. * Yes Amateur Athletic Minor Waiver and Release of Liability AMATEUR ATHLETIC MINOR WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in Northport-East Northport Basketball Program (Sponsored by the Eaton's Neck Youth Club, Inc.) athletics/sports program, and related events and activities, the undersigned: 1 .Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. 4. Release, waive, discharge and covenant not to sue Eaton's Neck Youth Club, Inc., its affiliated clubs, their respective administrators directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and leasers of premises used to conduct the event, all of which are hereafter referred to as "releases", from any and all liability to each of the undersigned, his or her heirs and next of kin for any claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise. I have read the above waiver and release. Understand that I give up substantial rights by checking the box below and checking the box voluntarily. * I accept the waiver Refund Policy REFUND POLICY The policy of the Eaton’s Neck Youth Club Inc. is to issue no refunds after a child has played in a sanctioned practice or game. Prior to playing in a sanctioned practice or game a refund of the registration fee less an administrative handling fee, will be issued. If a child is injured during a sanctioned Eaton’s Neck Youth League practice or game and is unable to return for the remainder of the season, once the season has ended, a prorated credit, less an administration handling fee, towards the next season will be issued. Exceptions to this policy will be made for eligible seniors where a prorated credit would not be appropriate. Should Eaton’s Neck Youth Club Inc. be forced to cancel a season, or any part thereof, due to any New York State, Suffolk County or Northport-East Northport UFSD guidelines issued and/or enacted upon, a prorated refund (less an administrative handling fee) based on the number of games played versus the number of games scheduled will be made within a reasonable period of time. If a child drops out of Eaton’s Neck Youth Club Inc. by their own choosing for any reason, then no refund or credit will be issued. I have read the refund policy * I accept the refund policy If you are human, leave this field blank.