Loudoun Freedom Tryout Registration

Freedom Tryout Registration

Please fill out your information below to register for Loudoun Freedom basketball tryouts.

Player Name*

First Name

Last Name

Date of Birth*

2011-12 School Grade*

School

Home Phone*

Mother's Name*

First Name

Last Name

Mother's Address

City

State

Zip Code

Mother's Home Phone*

Mother's Cell Phone

Mother's Email*

Father's Name*

First Name

Last Name

(if different than mother's address)

Father's Address

City

State

Zip Code

Father's Phone

Father's Cell Phone

Father's Email*

Emergency Contact

First Name

Last Name

Emergency Contact Phone

Previous Experience

Please list any previous basketball experience

Other Commitments

Please list other sports commitments, activities, or vacations in spring 2011 that will affect availability (include potential practice or game times):

Medical Information

Basketball is a semi-contact, cardio-vascular sport requiring keen hand-eye coordination. Due to the strenuous nature of some activities, the participant is urged to consult his/her physician concerning fitness to participate. All activities present certain inherent risks and hazards, which the participant is urged to consider and which the participant assumes. List known health issues that would affect or interfere with her playing basketball (i.e. allergies, asthma, diabetes, osgood-slaughter knee condition, etc.). List the known treatments or methods of handling health issues.

Liability Waiver: I do hereby grant permission for the above named youth to participate in any and all activities of the Loudoun Freedom during the 2011 season. I assume all risks and hazards incidental to such participation including transportation to and from such activities, and do hereby waive, release, absolve, indemnify and agree to hold harmless the Loudoun Freedom, its respective coaches, assistants, agents, other players or parents/guardians, sponsors, supervisors, participants, volunteers and any other persons from any and all claims for damage or injury arising from any activities of this sports program. Permission is granted to the hospital and staff to provide any treatment that a physician deems necessary for the well being of the child.

Parent/Legal Guardian*

First Name

Last Name

Date Signed*

Uniform Jersey Size* Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large

Uniform Shorts Size* Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large

Preferred Uniform Number(s)*

Provide three. Numbers must have some combination of 0, 1, 2, 3, 4, 5 (i.e. 12, 15, 20, 22, 33, 45, 51)

Registration and Team Formation:

Registration forms and registration fee of $25 are due at tryouts. The registration fee serves to pay for tryout gym space. Potential team members will be notified after tryouts as to whether they will be invited to play on a team.

Girls Eligibility = Team level is determined by grade. Permission to play up a grade is at the discretion of the Loudoun Freedom director and coaching staffs.

Copies of birth certificates, and health informatio, and all club fees are due within 1 week of an invitation to play on a Loudoun Freedom team.

	Freedom Tryout Registration Please fill out your information below to register for Loudoun Freedom basketball tryouts.
	Player Name* First Name Last Name
	Date of Birth* Month Day Year
	2011-12 School Grade*
	School
	Home Phone*
	Mother's Name* First Name Last Name
	Mother's Address City State Zip Code
	Mother's Home Phone*
	Mother's Cell Phone
	Mother's Email*
	Father's Name* First Name Last Name
	(if different than mother's address)
	Father's Address City State Zip Code
	Father's Phone
	Father's Cell Phone
	Father's Email*
	Emergency Contact First Name Last Name
	Emergency Contact Phone
	Previous Experience Please list any previous basketball experience
	Other Commitments Please list other sports commitments, activities, or vacations in spring 2011 that will affect availability (include potential practice or game times):
	Medical Information Basketball is a semi-contact, cardio-vascular sport requiring keen hand-eye coordination. Due to the strenuous nature of some activities, the participant is urged to consult his/her physician concerning fitness to participate. All activities present certain inherent risks and hazards, which the participant is urged to consider and which the participant assumes. List known health issues that would affect or interfere with her playing basketball (i.e. allergies, asthma, diabetes, osgood-slaughter knee condition, etc.). List the known treatments or methods of handling health issues.
	Liability Waiver: I do hereby grant permission for the above named youth to participate in any and all activities of the Loudoun Freedom during the 2011 season. I assume all risks and hazards incidental to such participation including transportation to and from such activities, and do hereby waive, release, absolve, indemnify and agree to hold harmless the Loudoun Freedom, its respective coaches, assistants, agents, other players or parents/guardians, sponsors, supervisors, participants, volunteers and any other persons from any and all claims for damage or injury arising from any activities of this sports program. Permission is granted to the hospital and staff to provide any treatment that a physician deems necessary for the well being of the child.
	Parent/Legal Guardian* First Name Last Name
	Date Signed* Month Day Year
	Uniform Jersey Size* Youth Small Youth Medium Youth Large Youth X-Large Adult X-Small Adult Small Adult Medium Adult Large Adult X-Large
	Uniform Shorts Size* Youth Small Youth Medium Youth Large Youth X-Large Adult X-Small Adult Small Adult Medium Adult Large Adult X-Large
	Preferred Uniform Number(s)* Provide three. Numbers must have some combination of 0, 1, 2, 3, 4, 5 (i.e. 12, 15, 20, 22, 33, 45, 51)
	Registration and Team Formation: Registration forms and registration fee of $25 are due at tryouts. The registration fee serves to pay for tryout gym space. Potential team members will be notified after tryouts as to whether they will be invited to play on a team. Girls Eligibility = Team level is determined by grade. Permission to play up a grade is at the discretion of the Loudoun Freedom director and coaching staffs. Copies of birth certificates, and health informatio, and all club fees are due within 1 week of an invitation to play on a Loudoun Freedom team.