2023/2024 Basketball Registration

Student Information

Legal First Name*

Answer Required

Legal Last Name*

Answer Required

Preferred Name

Answer Required

Grade*

Answer Required

Date of Birth*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Parent 1 Information

First Name*

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Work Phone

Number Required

Parent 2 Information

First Name

Answer Required

Last Name

Answer Required

Mobile Phone

Number Required

Emergency Contact Information

First Name*

Answer Required

Last Name*

Answer Required

Relationship to Student*

Answer Required

Email*

Answer Required

Phone*

Number Required

Family Doctor Information

Name*

Answer Required

Phone Number*

Number Required

Date of last physical exam? (must be within the last calendar year, please send in copy)*

Answer Required

Please list ALL allergies (medications, foods, insects, etc. If there answer is NONE write NONE)*

Answer Required

Does your child have any medical condition or asthma? if yes, please explain.

Answer Required

Please list all medications, including inhalers, prescribed to your child, as well as dosages and frequency of use: Write none if your child does not require any medication.

Answer Required

T-Shirt Size

Answer Required

Youth Small

Youth Medium

Youth Large

Youth XL

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Permission to Participate

I give permission for my child to participate in Tri-City Christian Academy's Basketball Program. I hereby verify that a completed physical examination has been conducted and report form has been submitted to TCCA Athletics. I hereby verify that my son/daughter has been cleared by a physician to participate in sports with no restrictions, please attach written confirmation. *

Answer Required

YES

I understand that participating in TCCA’s Middle and High School interscholastic sports program may require the early dismissal of my child from school. I understand that my child will have to complete any assignments missed by the early dismissal from school.

Answer Required

YES

I give permission to Tri-City Christian Academy and its employees and/or coaches to treat minor injuries or to transport my child to the nearest medical facility via ambulance in the event of a more serious injury or illness. I understand that the Tri-City Christian Academy employees and /or coaches will use their best judgment in treating my child. I will make every effort to be available by phone while my child is participating in this sport and will provide Tri-City Christian Academy with updated phone numbers as they change.

Answer Required

YES

I give permission to Tri-City Christian Academy and its employees and/or coaches to give my child acetaminophen (Tylenol) or Ibuprofen should he/she require it.

Answer Required

YES

Release of Liability

I/We acknowledge that participating in sports can be dangerous activities involving many risks or injury. In consideration of my child being allowed to participate in competitive sports, and intending to be legally bound, I/we do hereby release and forever discharge Tri-City Christian Academy (TCCA), its Board, officers, employees, coaches, administrators, and volunteers from any/all liabilities, claims, losses, demands, costs, expenses, or rights of action, of whatever kind or nature, which I/we have or which may hereafter accrue to me/us against TCCA, by reason of injuries sustained by my child participating in sports or in transit to or from participation in sports. I/we agree, for myself/ourselves and successors, that this Agreement and Release of Liability contains the entire agreement between myself/us and TCCA and that the terms hereof are contractual and not a mere recital.

Answer Required

YES

Basketball Registration Fees to be sent in ASAP - Cash or Check (memo TCCA Athletics) *

Answer Required

Pre-3 - K $75

1st & 2nd $100

3rd - 5th $120

6th - 8th $200

9th - 12th $225

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

2023/2024 Basketball Registration