Cobras AAU

Participant Information

Child Last Name *

Child First Name *

Child Grade *

Child Date of Birth

Parent Email *

Parent Cell

I give permission for my son(s)/daughter(s) to participate in the Cobras AAU Basketball Program. I agree to hold Whitman-Hanson, Cobras Basketball, Hanson Youth Basketball, Whitman Youth Basketball, the town of Whitman, the town of Hanson, all coaches, officials, trainers and agents free from any liability whatsoever in the event of any type of injury; I also certify that my son/daughter has been through a physical examination within the last 13 months and that he/she is healthy and able to participate in the program. I also give my permission for the program to seek medical attention for my son/daughter in the event of an injury, but again will not hold any of the above mentioned entities liable for said medical care or lack there of. We do NOT offer insurance for injuries and parents attest that their child is covered under their policy. *

Please list all Spring Commitments (sports, clubs, activities) *

Parent Name *

Date *