Please read the Medical Waiver and Release, then Complete the Player’s Registration Form

Athlete's Name: *

First

Last

Date of Birth: *

(Select the year first, then use arrows < >)

Grade: *

Current grade

Position: *

guard, forward, center, ect

Height: *

5'2"

Home Address: *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone#: *

Parent's Best Contact Number

Mother's Name: *

First

Last

Father's Name: *

First

Last

Email: *

Parent's Email

Signature *

I have read and agree with the Medical Waiver and Release form below.

Submit

Medical Waiver and Release

Urban Heroes Elite Inc. and any facilities where tryouts, practices or games will be played will assume no liability for injury or damages arising from the results of the above-named Athlete’s participation unless due to the willful misconduct or gross negligence of the part of Urban Heroes Elite Inc., its affiliates or agents. Due to the strenuous nature of basketball, the Athlete participating, and their parents are urged to consult their physician concerning the Athlete’s fitness to participate. Basketball presents certain inherent risks and hazards, which the participating Athlete is urged to consider and which the Athlete assumes.

I hereby approve of the participation of my child, the above-named Athlete, in the Urban Heroes Elite Inc. Basketball tryout program and consent to the emergency medical treatment for my child on my behalf. To the best of my knowledge, there ae no physical or other conditions which will interfere with my child’s participation.