Fresno Registration

Parent / Guardian Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

How many participants are you registering?(Required)

Participant #1

Name

First Last

Registration Fee

Price:

Date of Birth

Age

Sex

Weight

Height

Feet

Height

Inches

Team / Coach

T-Shirt Size

Primary Physician’s Name

Phone

Health Insurance Carrier

ID #

Health ID Card

Max. file size: 128 MB.

(Please attach a copy of Health Insurance Card)

Allergic to medication

Yes

Allergic to anything else

Yes

If yes please name the medications(Required)

If yes please describe(Required)

Taking any medication

Yes

Any chronical illness

Yes

If yes please name them all.(Required)

If yes, please name the illness.(Required)

Check the items that apply to your child

Asthma

Diabetes

Heart Problem

Sleep Walking

Seizure

Participant #2

Name

First Last

Registration Fee

Price:

Date of Birth

Age

Sex

Weight

Height

Feet

Height

Inches

Team / Coach

T-Shirt Size

Primary Physician’s Name

Phone

Health Insurance Carrier

ID #

Health ID Card

Max. file size: 128 MB.

(Please attach a copy of Health Insurance Card)

Allergic to medication

Yes

Allergic to anything else

Yes

If yes please name the medications(Required)

If yes please describe(Required)

Taking any medication

Yes

Any chronical illness

Yes

If yes please name them all.(Required)

If yes, please name the illness.(Required)

Check the items that apply to your child

Asthma

Diabetes

Heart Problem

Sleep Walking

Seizure

Participant #3

Name

First Last

Registration Fee

Price:

Date of Birth

Age

Sex

Weight

Height

Feet

Height

Inches

Team / Coach

T-Shirt Size

Primary Physician’s Name

Phone

Health Insurance Carrier

ID #

Health ID Card

Max. file size: 128 MB.

(Please attach a copy of Health Insurance Card)

Allergic to medication

Yes

Allergic to anything else

Yes

If yes please name the medications(Required)

If yes please describe(Required)

Taking any medication

Yes

Any chronical illness

Yes

If yes please name them all.(Required)

If yes, please name the illness.(Required)

Check the items that apply to your child

Asthma

Diabetes

Heart Problem

Sleep Walking

Seizure

In an emergency, if unable to reach parent, contact

Name/relationship

Phone

Name/relationship

Phone

In the event of a minor illness, do you authorize us to give your child common remedies(Required)

Yes

Attending Fresno Tournament has been a tradition for Ararat mainly with a purpose on team bonding, an opportunity for our coaches to head their teams through the weekend and to get to know players and families on a personal level and support our fellow Homenetmen Sassoon Chapter. It is expected from all of us to promote and ensure safety for all, to follow and abide by the Homenetmen Ararat Chapter codes of conduct, remember that we are all part of the extended family!

Would you like additional t-shirts for family members?

Yes

How many addtional shirts?

We will distribute t-shirts to family members if extras are available. Please limit 2 t-shirts for non participants.

Additional T-Shirt Size(Required)

Consent(Required)

I Agree

I, the undersigned parent or legal guardian of the above named, do hereby authorize and consent to any x-ray, anesthetic, surgical or medical treatment rendered by medical or emergency room staff licensed under the provisions of the Medicine Practice Act, in the state of California, Dept. of Public Health. It is understood that this authorizartion is given in advance of any specific diagnosis, treatment or hospital care deemed advisable by aforementioned physician in the excersise of the doctor’s best judgement.It is understood that every effort will be made to contact the undersigned prior to rendering treatment to the patient, but none of the above treatment will be withheld if the undersigned cannot be reached. This authorization is given pursuant to the provisions of section 25.8 of the civil code of California.

Consent(Required)

I Agree

I hereby authorize my son/daughter to participate in the 2023 Sassoon Tournament in Fresno, CA with Homenetmen Glendale "Ararat" Chapter April 22-23 2023.

Upon arrival to the hotel, "Ararat” coaches, leaders, volunteers or other representatives have the authority to search all athletes’ bags and personal belongings, and confiscate all material that they deem unsuitable and/ or unnecessary for this trip.

I waive any liability and release Homenetmen Glendale “Ararat" Chapter and its employees and volunteers from any and all liability for any injury, damages, or harm that occurs to my child as a result of his/her participation in, or travel to from the Fresno Tournament. I understand that basketball is a physical contact sport that involves a risk of injury and I assume the risk of any injury to my child.

This is to authorize the performance of necessary medical treatment in case of illness or accident when neither parent cannot be located.

Parents will be responsible for any DAMAGES caused by their children to any property during the trip to Fresno.

Consent(Required)

I have read and agree to the waiver below.

Read Waiver (PDF)

Signature(Required)

Billing Address(Required)

Street Address City State ZIP Code

Credit Card(Required)

Cardholder Name

Card Details

Total

Fresno Registration

Participant #1

Participant #2

Participant #3

In an emergency, if unable to reach parent, contact

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