Head Coach's Name *

First Name

Last Name

Assistant Coach's Name *

First Name

Last Name

Head Coach's Phone *

(###)

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Asst. Coach's Phone *

(###)

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Athlete's Name *

First Name

Last Name

Parent or Guardian's Name *

First Name

Last Name

Phone

(###)

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Secondary Contact *

First Name

Last Name

Phone

(###)

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Liability Waiver *

By checking this box, I acknowledge and agree to the following: I understand that participation in The Gauntlet Basketball League involves physical activity (e.g., running, jumping, contact) that may result in injury. I voluntarily assume all risks and responsibilities associated with participation. I agree to follow all safety rules and will immediately report any injuries or concerns to a 55Buckets coach or trainer. I certify that the athlete is: Not under medical care for any injury or illness that would limit safe participation. Not currently recovering from any orthopedic condition or injury. Has no history of fainting or other issues that may affect participation in strenuous activity. In good health and capable of safely engaging in high-intensity sports activity. I understand that I am responsible for providing adequate medical insurance coverage for any injury or illness that may occur. I hereby release and hold harmless 55Buckets, The Gauntlet, J-One Training, Forza, Box2U, and their directors, staff, volunteers, and affiliates from any and all liability for injuries or damages that may occur during participation.

By checking this box, I certify that I have read and agree to the terms above on behalf of the registered athlete.