Registration Mentorship – Teach And Ball

I hereby give consent to Teach and Ball to register me with their Mentorship Program and/or any additional programs selected. I understand that this form will register only one TAB Educational Program member at time.

Note: It will not be necessary to complete this form again as long as the student is with Teach and Ball, who will hold this form. This form must be retained by TAB for at least five (5) years or until the player’s 18th birthday, whichever occurs last. Remember to update this information with TAB immediately as required. Any updates can be sent to [email protected]

Student's Name *

Student's Birthdate *

Gender *

Home Address *

Parent/Guardian Information

Parent/Guardian Name *

Phone Number *

Alternative Phone Number

Email *

Emergency Contact Information (1)

Emergency Contact Name *

Relationship *

Phone Number *

Alternative Phone Number

Emergency Contact Information (2)

Emergency Contact Name *

Relationship *

Phone Number *

Alternative Phone Number

Additional Information

Please list the student's allergies, if any

Please list student's medical conditions, if any

List any other alerts, if any

Would you like to register for multiple programs? Please select additional programs below.Education ProgramBasketball ProgramSoccer Program

Medical Treatment Authorization and Liability Waiver

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with basketball and/or soccer, and hereby release, discharge, and otherwise indemnify the organization, Teach and Ball, their sponsors and its affiliated organizations, partnering organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the basketball player named above as a result of that player’s participation in Teach and Ball’s basketball programs and/or being transported to or from the same, which transportation I hereby authorize.

Minor (Child) Photo/Video Release Form

I hereby authorize Teach and Ball to publish photographs taken of me and/or the undersigned minor children for use in the Teach and Ball’s printed publications and website.

I release Teach and Ball from any expectation of confidentiality for the
undersigned minor children and attest that I am the parent or legal guardian of the child or children listed above and that I have the authority to authorize Teach and Ball to use their photographs and videos.

Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use. I acknowledge that since participation in publications and website produced by
the Teach and Ball confers no rights of ownership whatsoever.

I release Teach and Ball and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor(s) listed above.

Do you consent to the above Medical Treatment Authorization and Liability Waiver? *YesNoNot applicable (If signing up for education, or mentorship program)

Do you consent to the above Minor (child) Photo/Video Release? *YesNo

Keeping Tabs!

Registration Fee: $25.00 Please click here to make your payment. Another window will open up, once payment has been made come back to this page to complete your registration.