Consent Form

Please print this out and bring it in with your birth certificate.

I hereby certify that the information listed below regarding me is correct and I agree to devote my entire services as a Stroudsburg-Reeders Hornet Basketball League participant to:

TEAM__________________________________________________________________

By signing this document I agree to abide by all rules, regulations, and decisions of the Stroudsburg-Reeders Hornet Basketball League.

Name of PLAYER:______________________________________ Tele #(___)____________

ADDRESS:______________________________________________________

CITY/STATE/ZIP:________________________________________________

DATE OF BIRTH:____________________________________

Shirt Size___________

I/We the parent and/or guardian of the aboved named candidate for the Stroudsburg-Reeders Hornets Basketball League, hereby give my approval to his/her participation in any and all activities of the participation, including transportation to and from the agree to hold harmless organizers, sponsors, supervisors, coaches, and agents from claims arising out of injury to my son/daughter, except to the extent and in the amount covered by accident or liability insurance.

This contract is for the entire eligiblity of the participant.

In WITNESS WHEREOF, the parties hereunto have hereunto set their hands and seals this__________________Day of________________, 2003/2004

Signature of Parent or Guardian:_____________________________________________________

Signature of Parent or Guardian:_____________________________________________________

Signature of Participant:____________________________________________________________

Signature or R.H.B.L. Official:______________________________________________________


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