Hastings Public Pool Fundraising Team
Hastings Public Pool
Hastings
Hastings
Fundraising
Public
Public
Team
Pool Fundraising
Pool Team
Fun
Perk Up the Pool
“ Perk Up the Pool ” PerkPerk
Up the Pool
Up the Poo
33on
Tournament
on 33 Basketball
Basketball Tournament
3
3 on
on
3 Basketball
3 Basketball
TournamentTour
$30.00/team
July
18th
& 19th,
19th, 2015
2015
Registration
Form
$30.00/team$30.00/team
July
$30.00/team
18th &
JulyJuly
18th
Registration
& 18th
19th, 2015
&
Form
19th,
Regist
3 on 3 Basketball Tournament – Registration Form & Waiver
3 on 3 Basketball Tournament
–3 Registration
on33 Basketball
Basketball
Form
Tournament
& Waiver
– Registration Form
& Waiver
3 on
Tournament
– Registrat
Team
Name:__________________________________________________________
Team
Name:__________________________________________________________
Team Name:_______________________________________________________
Team Name:___________________________________
Team
Captain’s
Name:__________________________________________________
Team Captain’s Name:__________________________________________________
Team Captain’s
Name:_______________________________________________
Team Captain’s
Name:___________________________
Captain’s
Captain’sAddress:______________________________________________________
Address:______________________________________________________
Address:__________________________________________________
Captain’sCaptain’s
Address:______________________________
Captain’s
Captain’sPhone:_______________________________________________________
Phone:_______________________________________________________
Phone:___________________________________________________
Captain’sCaptain’s
Phone:________________________________
E-mail
forforTeam
or
E-mail
TeamCaptain
Captain
orContact:________________________________________
Contact:________________________________________
E-mail
for Team
Captain or or
Contact:____________________________________
E-mail
for
Team
Captain
Contact:________________
Name
PhoneNumber
Name
Number & Phone
Name
Grade
&Number
PhoneDate
Number
of Birth
GradeGrade
Date of
T-Shirt
Birth Date
Size
Male/Female
of BirthT-Shi
Name
&&
Phone
Grade
Birth Male/Female
Male/Female
T-Shirt
Size
2014yr.
yr.
2014
2014 yr.
YL,YL,
SM,
M,M,
LG,LG,
XL,XL,
XXLXXL
2014 yr. YM,
YM,
SM,
YM, Y
AgeDivisions:
Divisions:99&&under,
under,
Age 10-11,
10-11,
Divisions:
Age12-13,
12-13,
Divisions:
14-15,
99 &
& 16-18,
under,
under,
10-11,
19 & older,
10-11,
12-13,3014-15,
& older
12-13,
16-18, 19 14-15,
& older, 30 16
&o
Age
14-15,
Age Divisions:
11-15 years
and16-18,
16 & up19 & older, 30 & older
ALL PLAYERS ANDALL
A PARENT/GUARDIAN
PLAYERS
ALL PLAYERS
AND
FOR
AND
EACH
AA PARENT/GUARDIAN
PARENT/GUARDIAN
PLAYER MUST SIGN
FOR
THIS
EACH
WAIVER
PLAYER
FOR
MUST
EACH
SIGN THIS
PLA
W
ALL
PLAYERSAND
ANDAAPARENT/GUARDIAN
PARENT/GUARDIANFOR
FOR EACH
EACH PLAYER
WAIVER
ALL
PLAYERS
PLAYERMUST
MUSTSIGN
SIGNTHIS
THIS
WAIVER
understand
by signing
signing this
I acknowledge
and
assume the risks
I understand that Ibyunderstand
signing thisI document,
that
Ithat
acknowledge
by
anddocument,
this
assumedocument,
the
risks
I acknowled
I Iunderstand
that
by by
signing
thisthis
document,
I acknowledge
and assume
the risks
understand
that
signing
document,
I acknowledge
and assume
theinherent
risks in the
theon
3 onherby
3 basketball
herby
The City
of Ithac
inherent in the 3 on
inherent
3 basketballinherent
in
tournament
thein 3
and
3
basketball
relievetournament
The Citytournament
of and
Ithaca,
therelieveand
herby
3 on 3 inherent
basketballintournament
hereby relieve:
The Hastings
Borough,
Fundraising
Team/Members,
the 3 on 3 and
basketball
tournament
and herby
relievethe
The
City of Ithaca,
the
ICAA,
and
ICAA,
Ithaca
and and
Ithaca
Funfest
Sponsors
of any andof
all any
liability.and all liability
ICAA, and Ithaca Funfest
Sponsors
of any
allFunfest
liability.Sponsors
and Ithaca
the Hastings
Pool
Sponsorsofofany
anyand
andall
allliability.
liability. 4 Players (sub) welcome.
ICAA, and
Funfest
Sponsors
Player’s Signature:_______________________________
Player’s Signature:________________________________________Date:______
Player’s Signature:________________________________________Date:__________
Player’s
Signature:________________________________________Date:__________
Parent/Guardian
Parent/Guardian
Signature:_______________________
Signature:_________________________________Date:______
Parent/Guardian
Signature:_________________________________Date:__________
Parent/Guardian Signature:_________________________________Date:__________
Player’s Signature:_______________________________
Player’s Signature:________________________________________Date:______
Player’s Signature:________________________________________Date:__________
Player’s
Signature:________________________________________Date:__________
Parent/Guardian
Parent/Guardian
Signature:_______________________
Signature:_________________________________Date:______
Parent/Guardian
Signature:_________________________________Date:__________
Parent/Guardian Signature:_________________________________Date:__________
Player’s Signature:_______________________________
Player’s Signature:________________________________________Date:______
Player’s Signature:________________________________________Date:__________
Parent/Guardian
Parent/Guardian
Signature:_______________________
Signature:_________________________________Date:______
Parent/Guardian
Signature:_________________________________Date:__________
Player’s
Signature:________________________________________Date:__________
Parent/Guardian Signature:_________________________________Date:__________
Player’s Signature:_______________________________
Player’s Signature:________________________________________Date:______
Player’s Signature:________________________________________Date:__________
Parent/Guardian
Parent/Guardian
Signature:_______________________
Signature:_________________________________Date:______
Parent/Guardian
Signature:_________________________________Date:__________
Player’s Signature:________________________________________Date:__________
Parent/Guardian Signature:_________________________________Date:__________
Completed registration
Completed
form
Completed
and waiver
registration
registration
with your
form
check
and
form
need
waiver
to
and
with
be your
waiver
check need
wit
t
Completed registration form and waiver with your check need to be dropped off
dropped off
to Alley-T
by
August,your
17 to
2013
dropped
off
Alley-T
byAlley-T
August,
dropped
off
to
by Augu
Completed registration
form
andOffice
waiver
check
need
to be 17 2013
at Hastings Borough
bywith
July 16, 2015.
Checks
Checks
payable
to : “Perk Up
to
the: Park”
“Perk Up
Checksoff
payable
to : “Perk
Up thepayable
Park”
dropped
to Alley-T
by August,
17 2013
Checks
payable
to
: “Perk
Up
the
Pool”
t
en
m
a
rn
Registrations
can
also
Registrations
be
mailed
Registrations
to
can
can
also
also
be
be
mailed
mailed
Questions
to
to
or
Concerns:
Questions
or Concer
u
To
Checks
payable
to
:
“Perk
Up
the
Park”
e
T
e
th
a
t
m
a
e
C
b
l
a
il
p
w
ta
s
ins
Registration can [email protected]
be mailed to:
Alley-T Alley-T
location Alley-T
Are Ricaaperkupthepark@yah
Registrations
Questions or Concerns:
e
rial Gym can also be mailed to
p
o103
so
n
si
Mem
ble
S. Jeffery Ave.103 S. Jeffery
103 S. Jeffery
Ave.
Ave.Borough Office
Hastings
F
astings Park
o
[email protected]
r
& HAlley-T
A
ll
(3
) 5 minuMI
Ithaca, MI 48847 Ithaca,
48847
MI 48847
teIthaca,
207 5th Avenue
Team Member
103
S.
Jeffery
Ave.
p
er
io
d
s
ATTN: Jenna-ICAAATTN: Jenna-ICAA
ATTN: Jenna-ICAA
Wearing Sames
Hastings, PA 16646
Ithaca, MI 48847
Color Shirt
le
ATTN: Sam Patterson
ATTN:
DoubJenna-ICAA
ion
inat
Elim
Questions or Concerns: [email protected]