2009 - 2010 INDY HOOPS INC.

*** OFFICIAL TEAM ROSTER ***

TEAM NAME Parent Consent on Back

_________________________________

Parent Signature is Required

USSFA TEAM NUMBER ___________________

* PLEASE PRINT OR TYPE * A team may have 12 players maximum

Uniform # and NAME

ADDRESS

CITY

ZIP CODE

DATE OF BIRTH

HOME PHONE

SCHOOL/GRADE*

USSFA #

SCHOOL/GRADE* School name and grade for the 09-10 year Submission of your roster to Indy Hoops, Inc. is consent on behalf of the Players and coaches to use their names and photographs on the Indy Hoops website or other related publications.

I certify that all information is correct and each athlete listed on lines 1 through 12 comprise the Official Roster of our Club team & reside and feed into in the same defined public high school district.

Asst. Coach

Card #

Coach Signature

Card #

Address

Coach Name (print)

Phone #

Address

Bench Personnel

Card #

City & Zip

Phone #

# Home( )

E-Mail-

2009 - 2010 INDY HOOPS INC. *** OFFICIAL TEAM ROSTER *** TEAM NAME:____________________________

United States Sports & Fitness Association and Indy Hoops, Inc. Release of Liability and Parent/Guardian Consent:

In consideration of accepting this application and for permitting the athlete to participate in activities organized by United States Sports & Fitness Association (USSFA) and Indy Hoops, Inc. the athlete and parents/guardian acknowledge that such activities (games, team practice, travel, tournaments, and so forth) expose the athlete to the risk of injury, loss, or death and the athlete and parent/guardian do hereby Release, Discharge, Hold Harmless and Agree Not to Sue or Seek Recovery from the USSFA and Indy Hoops, Inc. or the directors, officers, employees, volunteers, coaches and officials of either organization, or from the facility, where the activities take place, and the employees, agents, and representatives of such facility, from any such claim arising from an injury, loss or death of the athlete from such activity. This release of liability includes, but not limited to, the 2009-2010 Indy Hoops, Inc. Leagues and Tournaments.

Player Name	Parent Signature
1
2
3
4
5
6
7
8
9
10
11
12