2013-14 PLAYER TRYOUT REGRISTRATION FORM

 

APPLICATION INSTRUCTIONS

Mail all completed application materials to the following address:

[3309 Thames Place Hephzibah, GA 30815]

 

Please be sure to complete the following forms in their entirety and include them in the mailing:

•  2013 Player Tryout Registration Form (completed)
•  Player Release & Eligibility Form (completed & signed)

•  $[ 25.00 ] Early Registration Fee in form Money Order / Cashier’s Check made payable to: [Bryan Beaver/Elite Sports Group Global ] (Non-refundable)

 

All materials should be sent via traceable carrier (e.g., FedEx, USPS, UPS, DHL) to ensure delivery.

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DEADLINE: [October 12, 2013] (Georgia-Lina Lady Canes/Atlanta Lady Tarheels/             Metro Atlanta Lady Hornets

 

 

_____________________________________________________________________

 

PERSONAL & EMPLOYMENT DATA:

First Name __________________ Last Name ______________________ Middle Initial _____

Email Address________________________________________________________________

Home Address _____________________________________________________________________

City ____________________________________________ State ______________ Zip ___________

Home Phone # _____________________Cell Phone # ______________________________

Birth date ________________       Age _____________             State of Birth ____________ Marital Status _________________ Height _________ Weight _______

Driver’s license #_______________________________ State of License________________

U.S. Citizen Yes [ ] No [ ] Other ________________________

Employer and/or School ___________________________ Work/School # _______________

Occupation _______________________________________________Full Time [ ] Part-Time [ ]

Have you ever been arrested? Yes [ ] No [ ]

If yes, please provide details_____________________________________________________

 

What mode of transportation will you be utilizing for your travel? Flying [ ] Driving [ ]

 

EDUCATIONAL DATA:

Name of High School__________________________________City______________________State_____

Did you graduate? Yes [ ] No [ ] If yes, when? _____________________________________

Name of College/University________________________________City___________________State___

Did you graduate? Yes [ ] No [ ] If yes, when? _____________________________________

If no, current year? _________________________________

 

PLAYING EXPERIENCE:

High School -- Yes [ ] No [ ] If yes, what year(s)? _________________________________________

College -- Yes [ ] No [ ] If yes, what year(s)? _________________________________________

Professional -- Yes [ ] No [ ]

If yes, what team(s) and what year(s)?

____________________________________________________________________________

____________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

 

 

2013-14 Player Tryouts

PLAYER RELEASE & ELIGIBILTY FORM

 

 

In consideration for my participation in the 2013 Georgia-Lina Lady Hurricanes/Atlanta Lady Tarheels/Metro-Atlanta Lady Hornets (“Teams”) WBCBL Semi-Professional League Player Tryout (“Tryout”), and for other good and valuable consideration, receipt of which is hereby acknowledged, I, by my signature below, hereby acknowledge and agree to all of the terms set forth in this Release and Eligibility Form. Accordingly, I hereby:

 

 

1. Declare that I have satisfied all applicable requirements of subsection (a) below and one of the requirements of subsection (b) below:

a. The player (I) is or will be at least eighteen (20) years of age during the calendar year in which the WBCBL season is held, and (ii) with respect to a player who is not

An International Player (as defined below), has graduated from high school (or, if the player did not graduate from high school, the class with which the player would

Have graduated had he graduated from high school has graduated); and

b. Either (I) The player has not attended a college or university in the United States during the academic year that takes place during all or any part of the Season; or (ii)

The player has no remaining intercollegiate basketball eligibility.

c. For purposes of this section, an "International Player" is a player: (I) who has maintained a permanent residence outside of the United States for at least the three (3)

Years prior to the WBCBL season, while participating in the game of basketball as an amateur or as a professional outside of the United States; (ii) who has never

Previously enrolled in a college or university in the United States; and (iii) who did not complete high school in the United States.

2. Acknowledge that there are risks associated with the strenuous athletic and physical activity that I will be involved in during the Tryout;

3. Acknowledge by this writing, that Women’s Blue Chip Basketball League, LLC (“WBCBL”) and Team have recommended that I obtain medical clearance from a physician prior to my

Participation in the Tryout. I understand the risks attendant to my failure to obtain medical clearance. By my signature below, I hereby represent that I either have received such

Medical clearance or, contrary to the recommendation of WBCBL and Team, have decided not to obtain such medical clearance. I also understand the risks inherent in

Participating in the Tryout;

4. consent to undergo examination by any physician, hospital, laboratory, clinic, and other health care provider (“Health Care Provider”) designated by WBCBL or Team and

Authorize any such Health Care Provider to use and/or disclose to WBCBL and Team and/or the physicians and/or officials of any WBCBL team any health or medical record,

including but not limited to, all information relating to any injury, sickness, disease, condition, medical history, laboratory or test result, medical or clinical status, diagnosis,

Treatment or prognosis (“Health Information”) obtained in conjunction with any such examination for any purpose relating to my participation and/or in connection with any

Potential employment by WBCBL. I further acknowledge that any Health Information disclosed may be redisclosed by the recipient of such information, that I will sign any

Additional individual authorizations as may be requested by WBCBL or Team to facilitate disclosure of Health Information, and that WBCBL shall not be obligated to me for any

Medical expenses or damages;

5. Release, waive and forever discharge any and all claims of damages or causes of action, including but not limited to, death, personal injury or loss or damage to property, which I,

Or any of my representatives, heirs, next of kin or assignees (“Representatives”) may have or which may hereinafter accrue to me or my Representatives in connection with (a) my

Voluntary participation in the Tryout, (b) the release and dissemination of Health Information, or (c) otherwise, and which may be asserted by me or my Representatives against

WBCBL, its parent, subsidiary or affiliated companies or entities, or its teams (collectively, “Released Entities”), and, for each such Released Entity, its respective officers,

Directors, owners, governors, officials, volunteers, employees, agents, representatives, successors and assigns (collectively, and together with the Released Entities, the

“Releases”), whether caused by the acts, omissions or negligence of any Release or by any other person or entity;

6. Give and grant perpetually to WBCBL and its designees the exclusive non-revocable right in and to my routines, performances, concepts, and other materials created in connection

With the Tryout and the proceeds of such performances and materials, including, without limitation, the perpetual and unlimited right to reproduce by any means (whether now

Known or hereafter developed) my voice, image, likeness, name, nickname, signature, biographical data, and any other identifying attributes (“Attributes”) and any and all of my

Performances, appearances, related materials, and all such effects made, produced or created in connection with the Tryout (together with Attributes, being referred to collectively

as the “Materials”), and the complete and unencumbered right throughout the world, to exhibit, record, reproduce, broadcast, transmit, publish, sell, distribute, perform, use and reuse

For any purpose, in any manner, by any means and in any medium, whether now known or hereafter developed, all or any part or parts of the Materials, without any further

Consideration to me or my Representatives and without further authorization; and

7. Acknowledge and accept sole responsibility for all of the hazards and risks associated with or related to my participation in the Tryout and for any damage or injury that I may

Cause to others; I expressly assume all risk of injury (including permanent disability and death) arising out of my participation in the Tryout, howsoever caused or arising and

Whether by negligence or otherwise, and accept personal responsibility for the damages following such injury, permanent disability or death.

 

 

By signing this form, I acknowledge that I have received, read and understand the provisions set forth above, and voluntarily consent to and accept the terms therein.

 

AGREED TO AND ACCEPTED:

 

Signature: _____________________________________________________Date:__________________

 

Name (Print):____________________________________________________