Participant’s name:_______________________________

Desired Jersey num_____ alternate number_____

Birth Date:_______________Age:_________ Height:________

Address:______________________________

City:__________________State:____ Zip:_________

E-mail Address_______________________________

Mom Cell Phone#___________________________

Dad Cell Phone#_________________

Names of Parent or Guardian:___________________________

Jersey /Shorts Size: ______________Shoe Size: ______ Position: _________

School: _______________Present Grade:__________

Existing Team_______________________Experience: Beginner - Avg - Advanced

Please fill out the waiver below. The waiver and liability MUST BE SIGNED to have a valid registration.Waiver of Liability and Promotion

Venom Sports-personal basketball training/skills program (hereinafter referred to as "Venom Sports") is not obligated to furnish any insurance. I, the parent or guardian of the applicant agree that "Venom Sports" and all individuals participating in the "Venom Sports" Basketball Program in any capacity, will not be liable for any causes of actions, claims and injuries arising out of the participation of the applicant in the "Venom Sports" Basketball Program, and hereby release all said individuals from such claims and liabilities. The undersigned acknowledges that in all sports there are certain risks of physical injuries and all players participate at their own risk, I, as legal guardian or parent of any applicant hereby consent to the participation of the applicant in the "Venom Sports" Basketball Program under the above mentioned conditions. I, also agree to abide by the young athlete's bill of rights.

I, as the parent or legal guardian, state that the child________________________________is in ample sports condition to participate in the "Venom Sports" training program. By signing this form, you exclude Acie Earl and any members of his staff from any normal injury and liability that might occur or labeled as normal sports injuries. If you do not wish to give consent for your player to be photographed, videotaped and/or filmed while participating in any "Venom Sports" activity and for the resulting photos, etc. to be used by "Venom Sports" for educational and promotional purposes please check the space below. I have read and understand the above:MAKE CHECKS PAYABLE TO VENOM SPORTS / email coachaearl@aol.com for more infoDate:______________________________________________________________Parent or Guardian Signature:______________________________________Address:___________________________________________________________

I do not wish for my child to be photographed or filmed._________ yes_________ or no___________Coach Earl 319-430-2537 or visit www.venomsportsgirls.com or www.venomsportstraining.com

Venom Sports Teams

JOINVENOM SPORTS GIRLS /BOYS BASKETBALL

TEAMS

TEAM TRYOUTS OCT 21

GIRLS 5-6PM Boys 6-7pm

2-11th Grade Girls/Boys [2011 school year]

GRANTWOOD GRADE SCHOOL GYM

1901 LAKESIDE DR, IOWA CITY,52245