Basketball Academy Registration | East Coast Panthers

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Enter password again^*

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Player First Name^*

Player Last Name^*

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Date of Birth^*

Grade^*

Parent First Name^*

Parent Last Name^*

Email^*

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Emergency Number^*

Address^*

Street Number

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Location and Session^*

Medical Alerts/Conditions^*

Terms & Conditions^*

As a participant in the above program, I recognize and acknowledge that there are certain risks of physical injury. I agree to assume the full risk of any injuries, damages or loss which I or my child may sustain as in result of such participation.
I hereby release the East Coast Panthers and the Masters School, along with all its officials, employees and volunteers of any liability in connection with damages and/or injuries that my child may sustain as a result of participating in the East Coast Panthers. 
I further understand that the Town of Somers does not provide medical coverage and it is my responsibility to provide appropriate coverage. I agree to waive and relinquish all claims and hold harmless the Town of Somers Parks & Recreation, its officers, agents, and employees from any and all claims.

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