Basketball Signup – Otselic Valley Recreational Program

Player Information

If you plan to sign up more than one player this form must be completed for each player.

Player Name *

First

Last

Player Birth Date *

Sex *

Shirt Size *

If you pick the "Other" option please indicate size below

Pants or Shorts Size *

If you pick the "Other" option please indicate size below

Please list size not listed

Example: Adult 2X Large

If shirt sizes run a little small from the vendor chosen would you like to go up one size? *

Pick the Team/Group your child should be playing with *

Medical Information

Does your child have any allergies or require any special medications? *

Example: Asthma, Juvenile Diabetes, ect.

Is it okay to apply medical aid in the event it is needed for your child? *

Parent/Guardian and Emergency Contact Information

Parent/ Guardian Name *

First

Last

Phone Number *

Best number to reach you in case of an emergency

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Town of Residence(Where you Vote/Pay Taxes) *

This may vary from your Physical Address, but is necessary for the Town of Otselic's billing purposes.

Emergency Contact *

First

Last

Phone Emergency Contact Number *

Best number to reach this person

Additional Emergency Contact

First

Last

Additional Emergency Contact Number

Best number to reach this person

Donations

Would you like someone to contact you about donating to the OV Rec program? *

Yes please
No thank you

Donations can be monetary, time, and/or supplies.

Please Read Below

We hereby agree that the Otselic Valley Youth Recreation Program (OV Rec), its members, coaches, and officers shall not be liable for any injury or loss that my child may sustain while participating in activities of any kind, whether sponsored by or under the supervision of the OV Rec and we agree to indemnify and hold harmless OV Rec, its members, coaches, officers, and designates of any claim whatsoever. *

Yes I agree to the above statement