Pre-Registration Form – Cupertino Hoops

Reg Date

Amount Paid

Check No.

Interviewer

Division

Assessment (1-Beg to 5-Adv)

Player First Name *

Player Last Name *

Street Address *

Country

(city and state not needed - Ex. 1234 Candy Lane)

Zip Code *

School *

Grade *

Grade as of Sept. Must be at least 9 years old by Sept 1st. 3rd graders REQUIRE league approval.

Gender *

Boy

Girl

Height *

In inches. For example, enter 62 if the player is 5 feet 2 inches.

Click Spec Sheet for Uniform Size Info:

Uniform Needed? *

Yes

Size (If Uniform Needed)

Select from Youth S to Adult XXL

Existing Jersey Number (If Uniform Not Needed)

To avoid duplicate numbers on the same team.

Returning Player or Family? *

Yes

If Returning Player or Family,

Last Season Played: 2022-23, 2021-22, ... or For a new player belonging to a returning family, please list sibling that is playing or has played in C-Hoops and their last season played

Coach/Teammate Request(s)

No guarantees

Emergency Contact Name *

Emergency Contact Phone *

Parent/Guardian Name [1] *

Parent/Guardian Phone [1] *

Parent/Guardian Email [1] *

Confirmation email will ONLY be sent to this address.

Parent/Guardian Name [2]

Parent/Guardian Phone [2]

Parent/Guardian Email [2]

Volunteer Position(s)

Coach

Asst Coach

Team Parent

Other

Player Physician Name *

Physician Phone *

Insurance Plan and Group No. *

Special Medical Condition(s)

Medical Release and Parental/Guardian Consent *

If the above named player needs emergency medical treatment and neither a parent nor the family physician can be reached, consent is hereby granted for such emergency treatment as may be considered necessary by an attending physician.

I Consent

Liability Waiver *

On behalf of my minor child (player named on this application), I hereby apply for his/her participation in Cupertino Hoops and do request Cupertino Hoops to accept this application. I hereby warrant that both myself and my child are familiar with the risks associated with participation in an active sport such as basketball. I do hereby agree and consent to my child’s participation in Cupertino Hoops during the current season and do assume all risks and hazards which are part of the conduct of the associated activities. I hereby release, absolve, indemnify, and hold blameless the Cupertino Hoops League, a California nonprofit corporation, its officers, directors, employees, agents and their sponsors, organizers, and supervisors of any and all liability for damage, injury, or expense of any kind arising out of or connected with my child’s participation in Cupertino Hoops. I am hereby informed that all rostered players are covered by an insurance policy in case of accident or medical emergency while participating in an activity sponsored by Cupertino Hoops. I further understand that in case of a medical emergency, my own personal medical plan, if I have one, will be used prior to the insurance provided through Cupertino Hoops. If I do not have a personal plan, the insurance provided by Cupertino Hoops will take effect immediately. As a condition of participation in the Cupertino Hoops program by the player named in this application, I acknowledge that I have read this consent form, and knowingly, on behalf of my child, assume all of the risks associated with participating in any way in the Cupertino Hoops program.

I Agree

Concussion Information *

Click Here for Concussion Information Sheet (courtesy of AYSO)

I Acknowledge that My Child and I have Reviewed the Information Sheet

Sudden Cardiac Arrest Information *

Click Here for the SCA Information Sheet

I Acknowledge that My Child and I have Reviewed the Information Sheet

Parent/Guardian Pledge *

I understand that the top three reasons kids play sports are to have fun, make new friends, and learn new skills. I understand that the game is for the kids and that I pledge to focus my energy on my child having fun and in keeping basketball in its proper perspective. I pledge to “Honor the Game.” I understand the importance of being a good example of sportsmanship to my children and all associated with the game. No matter what others may do, I will show respect for all involved in the game including coaches, players, opponents, opposing fans and officials. I understand that officials, coaches, and players make mistakes. If the official makes a “bad” call against my team, I will Honor the Game and be silent! I agree to honor the Cupertino Hoops Parent Pledge in my words and actions.

I Agree

Refund Policy *

Dropout requests must be made via Email or phone call to the league. 100% refund 2wks prior to start of practices; 80% refund up to 2wks after start of practices; 50% refund after that and prior to first game. Uniform must be returned.

I Acknowledge

PLEASE PRESS THE SUBMIT BUTTON TO COMPLETE YOUR PRE-REGISTRATION

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