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HOME » UPWARD

Upward Basketball at Cincinnati's Westwood UMC

Upward Basketball Camp Upward Basketball at Cincinnati's WUMC is for boys and girls in 1st-6th grades and features great benefits for players and parents... beginning with equal playing time and teams for everyone. Cheerleading is also available. Our format consists of a small devotion, skills development following practices and games.

 

PDF For specific information on this year's seaon, check out the 2009-10 Upward Brochure.

 

 

Upward Registration Form

*All Children Must Be Present At Registration.

Upward Child Information

I am registering my child for:
Basketball         Cheerleeding


First Name*:
Last Name*:
Middle Initial:
Gender*: Male Female
Phone Number*:
Birth Date: (mm/dd/yyyy)
Grade:
Street Address:
City:
State/Province:
Zip:
Parent's Email*:
Home Church:
(if you attend regularly, which one?)
Coach's Link:
(if you are coaching your own child)
Carpool Link:

Additional Inquiry/Question(s):

Parent/Guardian Information

Primary Parent/Guardian

Name:
Home Phone:
Work Phone:
Cell Phone:
Employer:
I can do one of the following for this player's team:
Coach Referee Team Parent

Alternate Parent/Guardian

Name:
Home Phone:
Work Phone:
Cell Phone:
Employer:
I can do one of the following for this player's team:
Coach Referee Team Parent

Emergency Contact

Name:
Home Phone:
Work Phone:
Cell Phone:

Assessment

How many years has your child played organized basketball?
Years

Parents: please help us better coach your child.
At play, your child is best described as (circle one):
1 2 3 4 5 6 7 8 9 10
1 being the least assertive and 10 being the most assertive

Preferences

Preferred Practice Night:
Monday Tuesday Wednesday Thursday Friday

Please Read Carefully (Signature is Required at End)

Does this child have any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, history of respiratory illness or any other significant medical condition?
Yes No

If yes, please state the condition:

If you wish to have your doctor contacted in case of an emergency:

Doctor's Name:
Doctor's Phone:

Emergency Authorization
I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorize the coaches, assistant coaches, or parent of team members acting in the capacity of activity supervisors/vehicle drivers, as me Agents. To consent to medical, surgical, or dental examination and or treatment. In case of emergency, I hereby authorize treatment, and/or care at any hospital. If there is an emergency and I cannot be reached, please contact the emergency contact

Authorization Signature:

Waiver of Liability, Disclaimer, and Permission
I, parent or guardian of the above named individual, acknowledge that participation in athletic events necessarily invokes risk of physical injury. I further acknowledge that the programs of Upward Unlimited are primarily administered by parents, who volunteer their time, rather than paid professionals. In consideration for accepting the registration of the named individual and permitting the voluntary participation of said individual in its programs, I hereby release, discharge, and hold harmless Upward Unlimited, its employees, volunteers and other representatives from any claims arising out of or relating to physical injury that may result to said individual while participating in an Upward Unlimited sponsored event, including any physical injury by the negligence of any official, referee, or coach while performing his/her duties during any practices or games.

Signature of Parent of Guardian:

Date: July 29, 2010