Boys & Girls Club of Noblesville Child Registration

High School Basketball Individual Waiver Registration

Please complete the information below to secure a place in the Boys & Girls Club of Noblesville High School Basketball League.
Please do not fill out this waiver until your captain has signed up your team.
Player Name*

First NameLast Name
Age*
Race*
Ethnicity*
School*
Grade*
Gender*
Birthdate*

MonthDayYear
Date
Household Information
Household Type*
Household Individuals*
(Provide the total number of individuals living in this household)
Household Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Household Income*
Does your child(ren) qualify for the free or reduced lunch program?*

YesNo
Parent / Guardian Information
Parent/Guardian *

First NameLast Name
Email*
Cell Phone Number:*

Area CodePhone Number
Work Phone

Area CodePhone Number
Add another Parent/Guardian

YesNo
Parent/Guardian

First NameLast Name
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Emergency Contact

Please provide an emergency contact in case of Parents/Guardians not be available.
Emergency Contact *

First NameLast Name
Phone Number:*

Area CodePhone Number
Add another Emergency Contact?*

YesNo
2 - Emergency Contact

First NameLast Name
2 - Phone Number

Area CodePhone Number
Additional Information

Please let us know if you have any special requests or concerns.
Requests / Concerns
Terms & Conditions

Boys & Girls Club Terms and Conditions
Emergency Medical Services

I/We understand our child(ren) may, while on the premises of the Boys & Girls Club of Noblesville, or during Club activity, become ill or injured, and that it may be impractical to notify me/us prior to a) Administering first aid b) Securing emergency medical attention. I / we therefore authorize the Club and its agents and employees to render such first aid and/or seek such emergency medical attention and authorize hospital or any Physician selected by the club to render such services.

Parent / Guardian Waiver

I/We understand that the Boys & Girls Club of Noblesville does not carry insurance covering my child's participation in this activity. I accept financial responsibility for any injury, which may occur, and agree to hold blame-less the directors, officers and volunteers of the Boys & Girls Club of Noblesville. against any and all litigation that may arise from my child's participation in this activity.
Medical Services*

I agree to these conditions
Photo-Publicity Release

Periodically, the media will cover activities at the Boys & Girls Club of Noblesville. By signing below, you are giving the media and the Boys & Girls Club of Noblesville permission to use your child's name and/or picture in the publicity.
Photo Release*

I agree and provide permissionI do not provide consent
Covid-19 Policy*

I have viewed and agree to the Covid-19 policy
Handbook*

I have viewed and agree to the BGCNI Handbook Policies
Please use your mouse to sign this application.

Clear
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High School Basketball Individual Waiver Registration

Please do not fill out this waiver until your captain has signed up your team.

Household Information

Parent / Guardian Information

Emergency Contact

Additional Information

Terms & Conditions