Player's Name First Last Team Captain Name First Last Home PhoneCell Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Occupation and Location Emergency Contact Name First Last Emergency Contact Phone NumberName of Program Registering For Start Date of Program Registering For MM slash DD slash YYYY End Date of Program Registering For MM slash DD slash YYYY HiddenDate of Form Being filled In MM slash DD slash YYYY I agree that I am taking a spot in a CMEK program. In the event of an injury, I understand that all refunds will be in the form of credit to a future CMEK camp program. I agree that you may utilize photographs, testimonials, email addresses, and information relating to my child's participation in CMEK activities on your web site and other CMEK publicity and literature. I hereby authorize the agents of CMEK ALLSTARS INC., to act for me according to his/her best judgment in any emergency requiring medical attention. I hereby release, discharge and indemnify CMEK ALLSTARS INC., staff, affiliated entities and their officers, agents and employees, from and against any and all claims, liability, causes of actions, lawsuits or awards arising out of or in connection with my or my child's participation in the program. Further, I hereby release, discharge and indemnify Hoop Heaven LLC, Waldwick Basketball LLC, staff, affiliated entities and their officers, agents, contractors and employees, from and against any and all claims, liability, causes of actions, lawsuits or awards arising out of or in connection with my or my child's participation in their youth leagues. I agree that program locations and times are subject to change based on availability, inclement weather, and enrollment. I have read the CMEK code of conduct with my child and promise to abide by it. I authorize this form to be used and updated accordingly for all CMEK programs that my child participates in for all future CMEK programs. (11/30/2019) I agree I agree that I am taking a spot in a CMEK program. In the event of an injury, I understand that all refunds will be in the form of credit to a future CMEK camp program. I agree that you may utilize photographs, testimonials, email addresses, and information relating to my child's participation in CMEK activities on your web site and other CMEK publicity and literature. I hereby authorize the agents of CMEK ALLSTARS INC., to act for me according to his/her best judgment in any emergency requiring medical attention. I hereby release, discharge and indemnify CMEK ALLSTARS INC., staff, affiliated entities and their officers, agents and employees, from and against any and all claims, liability, causes of actions, lawsuits or awards arising out of or in connection with my or my child's participation in the program. Further, I hereby release, discharge and indemnify Hoop Heaven LLC, Waldwick Basketball LLC, staff, affiliated entities and their officers, agents, contractors and employees, from and against any and all claims, liability, causes of actions, lawsuits or awards arising out of or in connection with my or my child's participation in their youth leagues. I agree that program locations and times are subject to change based on availability, inclement weather, and enrollment. I have read the CMEK code of conduct with my child and promise to abide by it. I authorize this form to be used and updated accordingly for all CMEK programs that my child participates in for all future CMEK programs. (11/30/2019)Date MM slash DD slash YYYY Δ
