Fees
__ Cash
__ Check (#_________)
Amount Paid ________
PrimeTime Basketball Club
REGISTRATION FORM
LAST, FIRST NAME:
PLAYER’S AGE AS OF January 1:
ADDRESS:
CITY, STATE, ZIP
COUNTY:
SCHOOL:
PARENT(S)
EMAIL ADDRESS:
CELL NUMBER:
DOB:
HEIGHT:
WEIGHT:
HOME TELEPHONE:
GRADE:
( ) MOTHER ( ) FATHER
PLAYER INFORMATION
* Best Positions____________________________________________________________________________
* LAST AAU TEAM: _________________________ * Other Sports Played:________________________
* Elementary School__________________________________________________ ___3rd _____4th ____5th
* Middle School _____________________________________________________ ____ 6th ____ 7th ____ 8th
* High School _______________________________________________________ ____ 9th ____ JV ____ V
ANY PHYSICAL PROBLEMS WE SHOULD KNOW OF? _____ NO _____ YES (Please explain):
___________________________________________________________________________________________________
FOR THE PARENTS (Please read carefully)
I, being the parent of the above named child, hereby give my approval for her participation in any and all PrimeTime Elite
Basketball activities including tryouts. I assume all risks and hazards incidental to such participation including transportation to
and from the activities: and I do hereby waive, release, absolve, indemnify and agree to hold harmless the PrimeTime Elite
Basketball, sponsors, organizers, owners of facilities used, supervisors, participants, and coaches for any and all claims arising
out of injury to my daughter except as covered by AAU Insurance, YBOA Insurance or Motor Vehicle Insurance.
I hereby authorize PrimeTime Elite Basketball officials, coaches, assistant coaches, team mothers, or any responsible persons
delegated to any of the above to take my child to the nearest hospital or any other accredited medical establishment for
emergency treatment in case of injury during practice and/or games if the parents are not available. I will assume any and all
financial responsibility. I give permission for my child to be used in advertisement for PrimeTime Basketball and PrimeTime
Elite Basketball; this includes my child being photographed, video taped and her information (such as stats, etc.) on the
PrimeTime website for positive promotion of the program. I understand that fundraising is a requirement of this club. Coaches
travel expenses to out of state tournaments is the responsibility of each individual team. I understand I have a duty to return all
uniforms at the end of the season. NO REFUNDS ONCE ACCEPTED.
Parent/Guardian Signature: ______________________________________ Date signed: _____________
IMPORTANT INFORMATION (Please complete)
Short Size: _____________ Jersey Size: ________________
Please make all checks payable to: Chris Henderson
Mail to: 752 Farm Hill Court
Woodstock, GA 30188
Further Contact Information: (770) 895-2005 [email protected]
Parental/Player Agreement
I understand the importance of attending practices. I understand my child must practice at home
to achieve her full potential.
I understand fundraising is a team effort and I am required to participate.
I understand that events are not mandatory; but participation influences a great team and social
skill building experience.
I understand that my child’s improvement is based on their work ethic.
I understand this is a competitive team. I understand that PLAYING TIME IS EARNED AND
NOT GUARANTEED!
I understand that communication is essential to a good relationship with the coach, players, and
parents.
I understand the coach can not work miracles but he/she will try. I understand that coaches will
make mistakes as they are human.
I have read and understand the direction and vision (see below) of PrimeTime Basketball.
PrimeTime Basketball’s vision is to establish a vigorous and challenging program that will
increase the mastery of the participants playing ability, academic progression and social
skill building. The primary goals of PrimeTime Basketball are the development and
strengthening of the overall player and prepare them for life. PrimeTime Basketball
Program will be based out of Metro- Atlanta area and will focus on ages 8-17.
PrimeTime Basketball’s concept is to create collegiate individual on all levels. The program
focuses on academic expectations and the structure of social skills. PrimeTime will prepare
players and present them with the necessary skill for evaluations based on the criteria on
which they will be judge by their choice of colleges. PrimeTime is aware of the lack of
quality programs in the area of youth basketball, thus PrimeTime is committed to meeting
the challenges and providing a program of substance centered on these beliefs.
Signature________________________
“We excel @books and ball”
PrimeTime
Date____________