Atlanta Celtics Registration Form
*** Please type or print information clearly. Return your completed registration form, a copy of your son’s birth certificate, a current photo and your certified check or money order for $275(made payable to the Atlanta Celtics, Inc.) ***
I am entering my son into the 9U, 10U, 11U, 12U, 13U, 14U, 15U, 16U, or 17U Age Division.
Player’s Name _________________________ Age_____ Birth-Date_________
Mailing Address ___________________________________________________________
City, State, & Zip ___________________________________________________________
Home # __________________________ Work # _____________________
Cell # _______________________ E-mail __________________________
Physical Restrictions/Disabilities ____________________________________
Physicians Name__________________ Physicians Phone #________________
Insurance Company ______________________ Policy #_________________
Did your son play for the Celtics last year? yes or no
Parent Registration Agreement
· There is a $275 donation to participate in the Atlanta Celtics’ Spring and Summer Basketball Program. This fee includes:
o AAU Membership
o AAU State Tournament (+ 1 additional tournament)
o Game Uniform
o 1 Pair of Basketball Shoes
o 1 Travel Bag
o Social Awareness Experiences
o Basketball Skill Development
o Team Practice Time
o Awards Banquet
· All players will be eligible for participation on the travel teams, but all selections are at the coach’s discretion.
· Parent/Guardian signature agrees to indemnify and hold harmless the Atlanta Celtics, Inc., its Board of Directors, Sponsors, Facility Owners and/or operators from claims, demands and judgments arising at any time your child/children are participating and/or traveling to participate with the Atlanta Celtics Program. Further, I hereby grant full permission to presenters of this program to use any photograph, videotape, DVD recording, or any other record of events for any purpose.
· Parent/Guardian signature below attest your agreement to adhere to all the rules and regulations of the facilities events are held and that you have read this registration form and grant full permission for your son to participate in the Atlanta Celtics Basketball Program.
Parent/Guardian Signature________________ Date____/____/____
Atlanta, GA 30317