2021 KB3 ELITE PEARLAND TEAM REGISTRATION FORM

SELECT YOUR TEAM:

*

10U TEAM
12U TEAM
14U TEAM
15U TEAM

Athlete Information

Athletes Name*

First Last

Athletes Cell

Athletes Email*

Enter Email Confirm Email

Athletes Twitter Handle

Athletes Instagram Handle

Athletes Shirt Size*

Athletes Short Size*

Athletes Glove Size*

Athletes Birthday*

Athletes Current Age*

Athletes School*

Athletes Current Grade*

Parent Information

Parent 1 - Name*

Parent 1 - Cell*

Parent 1 - Email*

Enter Email Confirm Email

Parent 2 - Name

Parent 2 - Cell

Parent 2 - Email

Enter Email Confirm Email

Credit Card Information

Cardholder Name*

Credit / Debit Card Number*

Card Expiration Date*

Card Security Code*

Zip Code*

Credit Card Authorization*

I agree to the payment schedule below.

I, parent or guardian of the above named athlete, authorize KB3 FOOTBALL to charge the credit / debit card listed above the KB3 ELITE Monthly Team fee of $95 on the dates listed below.

I understand that my information will be saved for additional transactions on my account. Any additional transaction (not listed below) will require additional email authorization by KB3 football. Additional transactions can be but are not limited to Gear, tourney fee and travel tickets. You may cancel this authorization at any time by contacting us. This authorization will remain in effect for the duration of the season or until it is canceled.

PAYMENT SCHEDULE:
1. February 5, 2021
2. March 5, 2021
3. April 5, 2021
4. May 5, 2021
5. June 5, 2021
6. July 5, 2021

Team Liability Waiver*

I agree to the Team Liability Waiver.

I, PARENT OR GUARDIAN OF THE ABOVE NAMED ATHLETE HEREBY GIVE APPROVAL TO PARTICIPATE IN ACTIVITIES WITH BLACKMON FOOTBALL LLC. I ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO SUCH PARTICIPATION INCLUDING TRANSPORTATION TO AND FROM THE ACTVITIES, AND DO HEREBY WAIVE, RELEASE, ABSOLVE, INDEMNIFY, AND AGREE TO HOLD HARMLESS BLACKMON FOOTBALL LLC, ORGANIZATION, THE ORGANIZERS, SPONSORS, SUPERVISORS, PARTICIPANTS AND PERSONS TRANSPORTING THE PLAYER TO AND FROM ACTIVITIES, FOR ANY CLAIM ARISING OUT OF AN INJURY TO THE PARTICIPANT, EXCEPT TO THE EXTENT AND IN THE AMOUNT COVERED BY ACCIDENT AND/OR LIABILITY INSURANCE HELD BY BLACKMON FOOTBALL LLC.

PHOTO/VIDEO/INTERVIEW RELEASE – I ALSO LAWFULLY GRANT BLACKMON FOOTBALL LLC PERMISSION TO DISPLAY PHOTOS & VIDEOS OF MY CHILD/CHILDREN, ETC FOR POSTIVE AND FAVORABLE PURPOSES. I UNDERSTAND THAT PHOTOS MAY BE USED ON THE WEB SITE OF KB3 FOOTBALL TRAINING. PHOTOS/VIDEOS MAY ALSO BE USED WITH LOCAL MEDIA ADVERTISING, NEWPAPER, MAGAZINE, AND SPORTS STATIONS.

I GRANT PERMISSION TO MANAGING PERSONNEL OR OTHER ORGANIZATION REPRESENTATIVES TO AUTHORIZE AND OBTAIN MEDICAL CARE FROM ANY LICENSED PHYSICIAN, HOSPITAL, OR MEDICAL CLINIC SHOULD THE PARTICIPANT BECOME ILL OR INJURED WHILE PARTICIPATING IN ACTIVITIES AT TIMES WHEN NEITHER PARENT IS AVAILABLE TO GRANT AUTHORIZATION FOR EMERGENCY TREATMENT.

Name

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