<p> South Coast Tigers Basketball Club Sherborne Academy Registration Form 2015/16 Home Office: 01202 886229 Head Coach: Michael Dronyk: 07726940575 Head Coach: Luca Dronyk: 07795484058 [email protected]</p><p>Players Name: ______</p><p>Address: ______</p><p>Postal Code: ______</p><p>Parents Mobile Number:______</p><p>Parents Email Address:______</p><p>Home Number: ______</p><p>DOB: ___/___/___ Age: ______</p><p>M/F: ______</p><p>Year: ______School ______</p><p>Medical Information/Allergies Etc: ______</p><p>Emergency Contact Name: ______Emergency Phone: ______</p><p>One time Membership Fee: £16 (includes club t-shirt) Fees: Payment Schedule: (Sept-Oct: 6wks) £30, (Nov-Dec: 7wks) £35, (Jan-Feb: 6wks) £30, (Feb-Mar: 5wks) £25, (Apr-May: 6wks) £30, (Jun-July: 8wks) £40. No reduction of fees due to non participation (such as illness, holidays, exams etc) of players.</p><p>I confirm that all details of fee payment are understood and agreed upon and the details on the registration form are correct</p><p>Player/Parent Signature: ______Print Name: ______Date: ______</p><p>T-Shirt Size: circle one</p><p>Male: S (38-40) M (42-44) L (44-46) XL (46-48) XXL (48-50) </p><p>Female: XS (30-32) S (32-34) M (34-36) L (36-38) XL (38-40)</p><p>Youth: Ages 7-8 Ages 9-10 Ages 11-12</p><p>Policies and Authorization</p><p>I realize that injuries can be a consequence of participating in this activity. I appreciate the character of the risk involved and I voluntarily assume for myself or on behalf of my child all risks of injury in participating in this designated activity (basketball). I have carefully considered how the possible consequences of injury may impact myself or my child's life, and I choose to accept this risk and allow myself or my child to participate in the designated activity (basketball).</p><p>In accepting this risk, I expressly and explicitly release, discharge and waive any and all responsibility of the South Coast Tigers Basketball Club and its coaching staff of any and all of the foregoing, pursuant to, and pertaining or relating to, or arising from, in any manner, injuries to myself or my child as a result of myself or my child's participation in this activity (basketball).</p><p>I give my permission to South Coast Tigers Basketball Club to use my or my child's photo/video image in various print or broadcast media to promote South Coast Tiger’s Basketball. Media outlets may include, but are not limited to, print ads, newspaper articles, billboards, leaflets and website pictures. </p><p>Once you have read the terms and conditions can you please sign and date below.</p><p>Signature of Player/Parent ______</p><p>Print Name ______Date ______</p>