2008 South Shore Patriots AAU Basketball Registration Form

Please print this form.




Player’s Name__________________________________________________________________
                                                 First                                                    Middle                                              Last        
                                                                       
Address_________________________________City_____________________Zip___________

Phone:___________________________Email:________________________________________

Fathers Cell___________________________Mothers cell_____________________________

Fathers Name_________________________ Mothers Name__________________________

Current Grade_____________________ Age__________ D.O.B._________________________

School Attending_______________________________________________________________


                                  Waiver / Release        

I, hereby, waive, release and hold harmless the South Shore Patriots organization, directors,
coaches, volunteers, and organizers from any liability for injury, illness, problems or accidents
that may occur to my child/guardian.

____________________________________________________(child’s name) while
participating in this program. I am aware that basketball is a contact sport and an injury
is a potential risk inherent to the game. I will not seek damages against South Shore Patriots,
it’s members, directors, coaches, volunteers or against Pembroke Community Middle School,
Pembroke High School, Hull High School if such accident or injury occurs.
I give permission for emergency medical treatment in the event I cannot be reached.


Parent signature for waiver__________________________________Date__________________

Player medical plan______________________________Medical Ins.#_____________________

Players Physician______________________________Phone____________________________