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Welcome to Basketball Registration

Welcome to Basketball Registration

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26Questions
  • 1
    What is the player's name?
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  • 2
    Please Select
    • Please Select
    • Pre-K
    • Kindergarten
    • 1st
    • 2nd
    • 3rd
    • 4th
    • 5th
    • 6th
    • 7th
    • 8th
    • 9th
    • 10th
    • 11th
    • 12th
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  • 3
    -
    Pick a Date
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  • 4
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  • 5
    Please Select
    • Please Select
    • Boy
    • Girl
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  • 6
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 7
    Dad's Name
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  • 8
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  • 9
    Mom's Name
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  • 10
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  • 11
    Primary email
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  • 12
    Secondary email
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  • 13
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  • 14
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  • 15
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  • 16
       Please print Name (Age)
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  • 17
    if above 6th grade
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  • 18

    RELEASE OF PHOTOGRAPHS / MESSAGES TO CELL PHONES.

    For valuable consideration the undersigned understands and agrees that video and photographs may be taken during the basketball programs and the undersigned hereby give permission to have his/her photo taken and authorizes the use and reproduction of said photos by Plainview Basketball Club.  All prints, files and negatives will be the sole property of Plainview Basketball Club.

    If participant is under the age of 18, his/her legal guardian hereby authorizes the use of photographs/videos as stated above. The undersigned hereby also give permission to the Plainview Basketball Club to send SMS Messages to parent’s cell phones regarding the basketball program.

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  • 19
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  • 20
    or upload an older one.
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  • 21

    LIABILITY WAIVER / MEDICAL TREATMENT CONSENT

    (In order for us to process your registration you must sign the liability Waiver /medical Treatment consent after you have read and agreed to the terms. Registrations where the waiver or the consent has been altered will not be processed)
    I hereby authorize qualified physicians to render medical treatment or care that they deem necessary for me or my family members in case of illness or accident during the program. In the event of injury and if a parent cannot be reached the Plainview fire district 516 938-2727 will be contacted to transport the injured to a nearby hospital.

     

     

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  • 22


    RELEASE OF LIABILITY FOR MINOR PARTICIPANTS

    READ BEFORE SIGNING
    IN CONSIDERATION OF {playersName} (Name Of Minor Child/Ward), my child/ward, being allowed to participate in any way in the Plainview Basketball Club /Basketball Academy LI related events and activities, the undersigned acknowledges, appreciates, and agrees that:

    The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

    1) FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and,

    2) I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,

    3) I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Plainview Basketball Club its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

    4) I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

    I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.



    UNDERSTANDING OR RISK
    I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.


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  • 23
    Next one is your Signature
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  • 24
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  • 25
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  • 26
    If YES Credit card payment option will follow. if NO your registration is not guaranteed. Early payment discount is applied as a rebate. You pay the full price then you will get a credit in 3-5 business days. 
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  • 27
    like Parent, Legal Guardian, Mother, Father
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  • 28
    Register for Basketball
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                              My Bag
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                              Great Product Name
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                              Quantity:1
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                              $20
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                              $20
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                              ORDER SUMMARY
                              Total costUSD
                              • Basketball Clinic8 weeks of basketball Instructional Clinics. Discounts if available will be given as a rebate. If you want to register for 16 weeks choose this item twice (you will get a rebate)
                                $450.00RemoveEdit
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                              • Equipment Bundle: Jersey + Ball + Bag ComboJersey , Basketball and Sports Bag Combo You can substitute Shorts instead of any 1 item. Choose 3 out of 4 items
                                $110.00RemoveEdit
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                              • Super Basketball Clinic - MonthlyDiscounts if available will be given as a rebate. This is a subscription
                                $250.00RemoveEdit
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                              • YEARLY Super Basketball Clinic (4 Sessions or 32 weeks)SUPER Basketball Clinic (Any 4 Sessions) Winter1, Winter2, Spring & Fall. During the School Year Starts In October Ends Mid June. It does not include summer. Join Any time for 4 Sessions.
                                $1,599.00RemoveEdit
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                              • Basketball 1 try-out Class/Clinic
                                $65.00RemoveEdit
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                              • Shooting Clinic - Additional to Super Basketball Clinic7th Grade and up Prerequisite: Ability to make Right & Left hand layups.
                                $275.00RemoveEdit
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                              • Mini Program (Any 5 weeks in 1 session )
                                $299.00RemoveEdit
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                              • Shorts
                                $39.00RemoveEdit
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                              • 1 on 1 Instruction1 on 1 Instruction (Does not include facility charges.)
                                $89.00RemoveEdit
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                              • Basketball Basketball Full size
                                $45.00RemoveEdit
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                              • Basketball BagSports Bag Recommended for 4th grade and UP
                                $45.00RemoveEdit
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                              • JerseyReversible Jersey
                                $45.00RemoveEdit
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                              • Games Basketball Games (for Teams only)  In addition to Super Basketball Clinic. You must buy a Jersey & a Short.
                                $299.00RemoveEdit
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