Primary Contact *

Best Contact Phone Number

(###)

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Team Contact *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact

Best Contact Phone Number

(###)

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I agree to the terms listed in the liability waiver. *

I, the undersigned Parent or Guardian of the minor, acknowledge that he or she is physically able to participate in all Score4More, Inc. recreational basketball tournament. In the event of an emergency, I herby authorize the director of the program or his or her designee to select the appropriate physician or hospital facilty and I authorize treatment of the above attendee on an emergency basis in the event such treatment becomes necessary. I will be responsible for all medical bills incurred as a result of illness or accidents for which medical treatment is necessary while the above applicant is in the care of Score4More, Inc.

I Agree