GEORGIA RED STORM REGISTRATION FORM PLEASE PRINT *A REQUIRED FIELD **AT LEAST ONE IS A REQUIRED FIELD PLAYER INFORMATION FIRST NAME* MI HEIGHT WEIGHT ft. PLAYED AAU yes JERSEY SIZE in. GENDER* DOB (MM/DD/YYYY)* SCHOOL NAME* lbs. YEARS PLAYED no SHORT SIZE LAST NAME* GRADE PREVIOUS TEAM NAME* TSHIRT SIZE SHOE SIZE JERSEY NUMBER CHOICE ST ND 1 choice 2 choice 3 RD choice PARENT/GUARDIAN INFORMATION PARENT #1 FIRST NAME* MI LAST NAME* RELATION* STREET ADDRESS* CITY* STATE* PHONE 1** PHONE 2** ZIP* PHONE 3** EMAIL ADDRESSES* PARENT #2 FIRST NAME* PHONE 1** MI LAST NAME* PHONE 2** RELATION* PHONE 3** EMAIL ADDRESSES* EMERGENCY CONTACT* PHONE* List any medical problem(s)/physical limitation(s) player has: PARENTAL/VOLUNTEER SUPPORT: COACH CONCESSION FUNDRAISING LEAGUE USE Date Received ___________ Birth Certificate Checked __________Payment Received ________ Cash _______ Check _______ (1) To abide by the rules of GA Red Storm, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with basketball and in consideration for GA Red Storm accepting the registrant for its basketball programs and activities. I hereby release, discharge and/or otherwise indemnify GA Red Storm, its affiliated organizations and sponsors, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. (2) To authorize my child’s school to verify the date of birth of my child from school records to a GA Red Storm authorized representative for the limited purpose of GA Red Storm player age verification. (3) To hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. (4) To hereby give my consent to GA Red Storm to take photographs, video recordings, and/or sound recordings of the above named player in documenting the activities of GA Red Storm’s programs. I grant GA Red Storm permission to use the prints, video/audio tapings, or any other reproduction of the same for GA Red Storm educational and promotional purposes in manuals, on flyers, on the internet, or in other publications.