SCORE SUMMER 2019 Registration

 Before clicking "Submit Form" below, please carefully read and understand our Terms and Conditions. We will contact you shortly after you submit this form via the email address you leave with us.

Student Athlete's Name *
Student Athlete's Name
Parent 1 Name *
Parent 1 Name
Address *
Address
Phone *
Phone
Player's Birthday *
Player's Birthday
Additional Parent/Guardian Name
Additional Parent/Guardian Name
Cell/Main Phone Number
Cell/Main Phone Number

Terms and Conditions

 We (child and parent/guardian) wish the child who signs below to participate in the S.C.O.R.E. Athletics Basketball Program. We realize that there may be a risk of injury during such participation and that certain injuries may occur during such athletic events and activities. We further agree that each child participating in SCORE activities must follow all staff instructions and behave in a manner that will reduce any risk of injuries. Failure to do so will be cause for the child’s dismissal from all SCORE activities. I (parent/guardian) hereby acknowledge, hereby release, acquit and forever discharge SCORE and the officers, directors, trustees, employees, coaches, agents, board members, insurers and Portland Public Schools from any and all negligence, claims, responsibility and liability of whatever kind of nature, whether arising from any injury or damage which may be sustained by my child as a result of my child’s participation in the SCORE program. In addition, I agree to defend and indemnify SCORE and the officers, directors, employees, trustees, coaches, agents, board members, insurers, of any and all manners of actions, negligence, claims, demands, damages, liability or expense of every kind of nature which may be incurred or arise by reason of my child’s participation in the program, including but not limited to any injuries my child may cause to other participants. I give permission to the physician selected by SCORE personnel to secure and administer treatment, including hospitalization for my child as named below. I agree to be responsible for any expenses, which may be incurred in providing emergency medical or surgical treatment for my child. My child has permission to participate in the SCORE Athletics Program and all of its activities. I understand that in order to provide a safe and cooperative experience, a child may be dismissed from the program for reasons including behavior, illness or injury. I have read and understand the above statements and also permit still and moving pictures of my child to be used for SCORE publicity. By clicking "Submit Form" above, I (parent or guardian) am agreeing to the Terms and Conditions stated.