Intermountain Hoops Top Twenty Showcase

INVITATION/REGISTRATION FORM

A $40 participation fee must accompany this form.

Name ___________________________________________   Birth Date ____/___/____

Home Address __________________________________________________________
                                                                                          
City:______________ State: ___ Zip:______ Phone:( ___)_________ (___) ________ 
                                                                                         Home                  Cell
E-mail ____________________________________GPA_____ ACT_____ SAT_____

High School Coach ___________________________      School __________________

HS Grad Year  20____Position _____ Height:___­__ Weight:_____ ­T-Shirt Size:___

Parent/Guardian ______________________________ Phone: (___)______________
                                                                                           (In case of Emergency)
Parent e-mail __________________________________________________________

     HEALTH AND BEHAVIOR GUIDELINES AND WAIVER OF LIABILITY
       NO PLAYER CAN PARTICIPATE WITHOUT THE SIGNED WAIVER

Health Insurance Co.___________________________________________________

Policy No. ___________________________Group No.________________________

I understand that participation in the Intermountain Hoops Fall Showcase (hereafter referred to as “Event”) involves potential strenuous activity and may cause bodily and emotional injury to others or myself. Any participant who does not abide by the rules, regulations and policies established by the Event is subject to dismissal without reimbursement or recourse. I hereby waive and release Intermountain Basketball Association, Layton Christian Academy,  event director and employees and all others associated with the event from any and all liability for any injury or illness, loss or liability while participating in the event. I hereby authorize the directors of the Event, event staff and trainers to act according to their best judgment in any emergency if I cannot be contacted. I understand that each event participant is required to have their own medical and accident insurance. I also understand that the Event retains the right to use for publicity and advertisements purposes, photographs and game films. I also agree to the release of the above information to various scouting services , college coaches and media.

________________________________________________________________________

                              SIGNATURE OF PARENT OR GUARDIAN

PLEASE SEND COMPLETED FORM AND CHECK PAYABLE TO IBA TO:

Intermountain Basketball Association

Event director David Hammer

2706 Parleys Way   Salt Lake City, UT 84109