2019 Basketball Registration Applicants Name*Date of Birth* MM DD YYYY Email* Street Address*Phone Number*City & StateZip*Elementary School Boundary*Association*School Attending*Grade*Is this candidate covered by Health Insurance?* Please Select ... YES NO Name of insurance company I/We, the parents or legal guardians for the above candidate for a position on a Chesterfield Basketball League team, hereby give My/Our approval to his/her participation in any and all league activities I/We assume all risks and hazards incidental to such participation including transportation to and from the activities and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the Chesterfield Basketball League, Inc., the organizers, sponsors, supervisors, participants and person transporting My/Our son or daughter, except to the extent and in the amount covered by accident or liability insurance. I/We agree to return all uniforms and other equipment issued to My/Our son or daughter in as good condition as when received except for normal wear and tear. I/We will furnish a certified birth certificate or other proof of birth of the above named candidate at this or initial sign in. I/We understand that My/Our son or daughter is an ineligible player if he/she is named on any roster of any official school basketball team, whether public, private or parochial, during the current school year. Signature*By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature in this Agreement.Date* Date Format: MM slash DD slash YYYY Product Name*Rookies (8 & Under)9 & UpTotal $0.00 Please Read before Hitting Submit After you hit the submit button, please wait for the page to redirect to PayPal. Once you are on PayPal you can either use your PayPal account or use your Debit/Credit Card Once this is done, you will be redirected back to the site, or you can simply sign off! Also, Check your email, you will see the assign documents for which you just filled out. Please keep these for your records. This iframe contains the logic required to handle Ajax powered Gravity Forms.