MHEA Eagles Basketball Registration - One Form Per Student
(Player and Parent must read and sign below before participating.)

MHEA Membership No.:

Parent Name
Last Name: Husband Name: Wife Name:

Address:

City: State: Zip: Phone:

Email Address:

Player Name :
Name: Grade: Date of Birth:

Doctor Name: Phone:

Emergency Contact Name: Phone:

Insurance Company Policy #

Please list medications, conditions, allergies, and pertinent information:

This Player Registration and Release Form is intended to include tryouts for teams, as well as participation on a team should your child be selected. Team participation includes, but is not limited to the following: workouts, practices, scrimmages, games, camps, retreats, fundraisers, and team ministry efforts.

Player: I understand that I can not be rostered on any other team while on a MHEA team. I also understand that previous participation in any MHEA sponsored program or personal or group workouts with individuals, including potential coaches, does not guarantee me a spot on a team.

Player Signature ____________________________________________ Date ______________________

Parent/Guardian: I give my permission for the below mentioned player to participate in tryouts, games, practices, and other related activities sponsored by the MHEA Eagles Basketball Program. This includes travel to and from such activities. I know of no reason, medical or otherwise, that could or should prevent the below mentioned player from participation. I list below any pertinent information, including conditions and medications taken by the participant. (I understand that MHEA Eagles basketball staff strongly recommends a consultation with a physician prior to participation in sports.) I give my consent for a MHEA representative or designee to obtain any medical care deemed necessary for the below mentioned participant, including, but not limited to, contacting a physician, calling for emergency care, administering first aid, and transporting to a medical facility. I also agree to be financially responsible for all cost associated with such assistance or treatment. I recognize that basketball is a contact sport and my child could be injured or become ill as a result. I waive any legal claim against MHEA Eagles Basketball Program, its staff, officers and volunteers, and the Memphis-area Home Education Association, its staff, officers and volunteers resulting from any illness or injury to the below mentioned participant incurred while participating in any related activities, including travel.

By my signature below, I hereby confirm that I have read, understood, and agree to this release statement, holding Memphis-area Home Education Association, Eagles Basketball, the coaches, representative officers and agents, harmless.

I also understand that my child’s previous participation in any MHEA sponsored program or personal or group workouts with individuals, including potential coaches, does not guarantee my child a spot on a team.

Parent/Gauardian Signature __________________________________ Date ______________________