2011 - 2012 INDY HOOPS, INC.
*** OFFICIAL TEAM ROSTER ***
	TEAM  NAME				GRADE  LEVEL __________         CLASS   "A" _____    "B" _____
							Parent Consent on Back
	* PLEASE  PRINT  OR  TYPE *			A team may have 12 players maximum			Parent Signature is Required
Uniform				Zip	Date of	Home
Number	Name	Address	City	Code	Birth	Phone	School / Grade *	USSFA #
	* SCHOOL & GRADE -- For the 2011-2012 School Year				I certify that all information is correct and each athlete listed on lines 1 through 12 comprise the
					Official Roster of our School team and reside in the same defined public high school district.
	Asst. Coach ________________________________       USSFA # ______________				USSFA Card # _______________
	Address/___________________________________________________________				Coach Signature  _____________________________________________
	City/Zip__________________________________________________________				Coach Name (print) __________________________________________
	Phone #  (        )_______________E-Mail_________________________________				E-Mail ______________________________________________________
	Bench Personnel ____________________________     USSFA # ______________				Home # __________________Cell #_______________________________
	Address___________________________________________________________				Address ____________________________________________________
	City/Zip____________________________________________________________				City & Zip: ___________________________________________________
	Registration Fee:    Team Membership - $10.00,  Youth - $10.50 each  &  Coach - $10.50 each
	2011-2012  INDY HOOPS, INC.     *** OFFICIAL  TEAM  ROSTER ***         TEAM  NAME: ____________________________
	United States Sports & Fitness  Association (USSFA) 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 2011-2012 Indy Hoops Leagues and Tournaments and USSFA Tournaments.
	Player  Name				Parent/Guardian  Signature
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	Registration Fee:    Team Membership - $10.00,  Youth - $10.50 each  &  Coach - $10.50 each
			MAKE  CHECK  PAYABLE  TO:  USSFA
			Mail  To:	USSFA			Phone #:   317-946-8755
				P.O. Box 50126
				Indianapolis,  IN   46250